by Harvard Pilgrim Health Care Institute

health care

Credit: CC0 Public Domain

A new thought piece led by the Harvard Pilgrim Health Care Institute with collaborators from Duke University and Kaiser Permanente Washington Health Research Institute highlights the challenges facing health care researchers and decision makers in the quest to improve population health in a constantly evolving health care landscape.

The authors offer strategies to enhance the effectiveness of pragmatic clinical trials and increase their impact on real-world health care settings. The Viewpoint appears October 2 in JAMA.

Pragmatic clinical trials, designed to inform health care decision-makers about the comparative benefits, burdens, and risks of health interventions, have seen a significant increase in interest over the past decade. Since 2012, the NIH Pragmatic Trials Collaboratory has supported 32 such trials, addressing critical issues like suicide prevention, opioid prescribing, and infection control.

Pragmatic clinical trials compare treatments in everyday clinical settings, rather than under ideal conditions. However, the authors note that the adoption of trial findings by health care systems has been inconsistent.

"Our goal is to ensure that the findings from these trials are not only scientifically sound but also readily implementable in diverse health care settings," says lead author Richard Platt, Harvard Medical School distinguished professor of population medicine at the Harvard Pilgrim Health Care Institute.

"Pragmatic clinical trials are designed to bridge the gap between research and care, and we believe this bridge can be built even more efficiently."

The authors identify key challenges and propose solutions to align trial goals with health care system needs, including:

  • Identifying relevant outcomes: Collaborate with health care leaders to determine the clinical or cost-saving outcomes that would motivate adoption.

  • Shortening trial duration: Designing trials to span two to three years to match the decision-making timelines of health care systems.

  • Conducting interim assessments: Utilizing interim analyses to provide timely information and potentially stop or modify trials early.

  • Considering costs: Understanding and planning for associated costs to ensuring interventions are sustainable post-trial.

"By accommodating the priorities of health care leaders and introducing adaptive trial designs, we can generate actionable evidence that truly improves patient care," adds Dr. Platt.

More information: Making Pragmatic Clinical Trials More Pragmatic, JAMA (2024). jamanetwork.com/journals/jama/ … 1001/jama.2024.19528

Journal information: Journal of the American Medical Association 

Provided by Harvard Pilgrim Health Care Institute