The Promise of Pragmatic Clinical Trials Embedded in Learning Health Systems.

Leah Tuzzio,Eric B Larson

doi:10.5334/egems.285

Abstract

This commentary describes the need for a different context to clinical research that could speed the discovery and implementation of evidence-based advancements to health care delivery. Pragmatic clinical trials (PCTs) are a promising type of trial conducted within real-world health care delivery systems like organizations within the Health Care Systems Research Network, that embrace research as part of their culture of continuous learning and improvement. In these learning health systems (LHSs) clinical practice influences research and vice versa. A goal of LHSs is to operationalize evidence generated by research, particularly PCTs, into improvements that are sustained after a trial ends. PCTs that demonstrate value to health systems and foster implementation could reduce delays in translating research into practice.

Highlights

Of the flood of research discoveries that could inform clinical practice, it has been reported that it may take up to 17 years for only 14 percent of research findings to be implemented into clinical care [1]
Production and uptake of clinical evidence is inefficient because most randomized clinical trials occur in settings that are separated from clinical care and do not always answer research questions that are relevant and meaningful to clinicians, patients, and health systems
The National Institutes of Health (NIH) Collaboratory Pragmatic clinical trials (PCTs) provide a collaborative mechanism through which funders, researchers, and health system stakeholders can efficiently generate knowledge and implement effective solutions

Summary

Introduction

Of the flood of research discoveries that could inform clinical practice, it has been reported that it may take up to 17 years for only 14 percent of research findings to be implemented into clinical care [1]. Clinicians and delivery systems are overburdened with providing routine care and addressing multiple other priorities and have little time for learning about new clinical evidence and integrating it into practice. This situation suggests that we need a different research context for generating and translating evidence into everyday practice. This commentary describes how pragmatic trials in learning health systems (LHSs) such as those in the Health Care Systems Research Network (HCSRN) provide that context. Strategies and Opportunities to Stop Colon Improve the rates of colorectal cancer

26 Federally Qualified Health Centers

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Findings

Conclusion