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Pragmatic Clinical Trials and Learning Health Care Systems: Strategies to Facilitate Implementation of Results into Clinical Care


Eric B. Larson, MD, MPH, and Leah Tuzzio, MPH, of the Kaiser Permanente Washington Health Research Institute and the NIH Collaboratory Health Care Systems Interactions Core working group.


Learning health systems; Pragmatic clinical trials; Implementation, dissemination, and sustainability; Embedded trials; Clinician engagement; Stakeholder engagement; Research partnerships

Key Points

  • A bidirectional relationship exists between PCTs and learning healthcare systems: learning healthcare systems are served by PCTs, and PCTs benefit from being conducted within a learning healthcare system.
  • PCT partnerships with health systems drive improvement and evidence-based practice. Results of PCTs are implementable and sustainable when aligned with the motivations, priorities, and challenges of the partner healthcare system.
  • When partnering, expect change, be flexible, and adjust as needed. Develop solutions together and always maintain communication.
  • Implementation and sustainability should be promoted from the outset of the PCT. Consider early on how the health system will adopt a successful pragmatic intervention when the trial is over.

Discussion Themes

Study teams should also get to know the motivations and passions of the non-physician staff, such as nurses and medical office assistants, to engage them in the process and integrate their roles in the workflow.
Critical to the success of the embedded PCT is the clinic champion—the person who “carries the torch.”
Are there strategies for reassuring operational leaders to address their concerns about delays or workflow disruptions when research is embedded in routine care?
How do we do effective PCTs that are not embedded in the healthcare system?

For More Information

The Learning Health Care System in America (National Academy of Medicine)


#pctGR, #LearningHealthSystems
@PCTGrandRounds, @Collaboratory1, @PCORnetwork

 Grand Rounds 5-12-17

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