A recent piece of thought leadership addresses the difficulties that healthcare researchers and policymakers encounter as they strive to enhance the health of the population amid a rapidly changing healthcare environment. The authors present methods to boost the effectiveness of pragmatic clinical trials and broaden their relevance in actual healthcare scenarios.
A recent thought-provoking article led by the Harvard Pilgrim Health Care Institute, in partnership with Duke University and Kaiser Permanente Washington Health Research Institute, sheds light on the hurdles healthcare researchers and decision-makers face in their efforts to enhance population health amidst a constantly shifting healthcare environment. The authors share approaches to improve the effectiveness of pragmatic clinical trials and amplify their influence in real-world healthcare settings.
This viewpoint was published on October 2 in JAMA.
Pragmatic clinical trials are designed to guide healthcare decision-makers about the relative benefits, drawbacks, and risks associated with various health interventions. Interest in these trials has notably surged over the last ten years. Since its inception in 2012, the NIH Pragmatic Trials Collaboratory has facilitated 32 such trials focusing on pressing issues, including suicide prevention, opioid use, and infection management.
These pragmatic trials evaluate treatments in everyday healthcare environments instead of controlled settings. Nevertheless, the authors point out that healthcare systems have been inconsistent in incorporating the findings from these trials.
“Our ambition is to ensure that the results from these trials are both scientifically valid and easily applicable across different healthcare environments,” states lead author Richard Platt, a distinguished professor of population medicine at Harvard Medical School, also affiliated with the Harvard Pilgrim Health Care Institute. “Pragmatic clinical trials are intended to connect research with care, and we believe this connection can be established more efficiently.”
The authors outline several key challenges and suggest solutions to align the objectives of trials with the requirements of healthcare systems, such as:
- Determining relevant outcomes: Work together with healthcare leaders to identify which clinical or cost-saving outcomes would encourage adoption.
- Reducing trial duration: Structure trials to take 2-3 years to align with the decision-making processes of healthcare systems.
- Implementing interim assessments: Use interim evaluations to provide timely insights and potentially adjust or conclude trials early.
- Assessing costs: Recognize and plan for related costs to ensure that interventions remain sustainable after the trial concludes.
“By aligning with the priorities of healthcare leaders and implementing adaptable trial designs, we can create valuable evidence that genuinely enhances patient care,” adds Dr. Platt.
