scholarly journals Justice and equity in pragmatic clinical trials: Considerations for pain research within integrated health systems

2021 ◽  
Author(s):  
Joseph Ali ◽  
Alison F. Davis ◽  
Diana J. Burgess ◽  
Daniel I. Rhon ◽  
Robert Vining ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Health Systems ◽  
Pain Research ◽  
Pragmatic Clinical Trials ◽  
Integrated Health

scholarly journals Improving pragmatic clinical trial design using real-world data

2019 ◽  
Vol 16 (3) ◽  
pp. 273-282 ◽  
Author(s):  
Susan M Shortreed ◽  
Carolyn M Rutter ◽  
Andrea J Cook ◽  
Gregory E Simon
Keyword(s):  
Clinical Trials ◽  
Trial Design ◽  
Suicide Attempts ◽  
Real World Data ◽  
Electronic Health Record Data ◽  
Pragmatic Clinical Trial ◽  
Pragmatic Clinical Trials ◽  
Sample Size Calculations ◽  
Record Data ◽  
Electronic Health

Background Pragmatic clinical trials often use automated data sources such as electronic health records, claims, or registries to identify eligible individuals and collect outcome information. A specific advantage that this automated data collection often yields is having data on potential participants when design decisions are being made. We outline how this data can be used to inform trial design. Methods Our work is motivated by a pragmatic clinical trial evaluating the impact of suicide-prevention outreach interventions on fatal and non-fatal suicide attempts in the 18 months after randomization. We illustrate our recommended approaches for designing pragmatic clinical trials using historical data from the health systems participating in this study. Specifically, we illustrate how electronic health record data can be used to inform the selection of trial eligibility requirements, to estimate the distribution of participant characteristics over the course of the trial, and to conduct power and sample size calculations. Results Data from 122,873 people with patient health questionnaire (PHQ) responses, recorded in their electronic health records between 1 July 2010 and 31 March 2012, were used to show that the suicide attempt rate in the 18 months following completion of the questionnaire varies by response to item nine of the PHQ. We estimated that the proportion of individuals with a prior recorded elevated PHQ (i.e. history of suicidal ideation) would decrease from approximately 50% at the beginning of a trial to about 5%, 50 weeks later. Using electronic health record data, we conducted simulations to estimate the power to detect a 25% reduction in suicide attempts. Simulation-based power calculations estimated that randomizing 8000 participants per randomization arm would allow 90% power to detect a 25% reduction in the suicide attempt rate in the intervention arm compared to usual care at an alpha rate of 0.05. Conclusions Historical data can be used to inform the design of pragmatic clinical trials, a strength of trials that use automated data collection for randomizing participants and assessing outcomes. In particular, realistic sample size calculations can be conducted using real-world data from the health systems in which the trial will be conducted. Data-informed trial design should yield more realistic estimates of statistical power and maximize efficiency of trial recruitment.

scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Accounting for quality improvement during the conduct of embedded pragmatic clinical trials within healthcare systems: NIH Collaboratory case studies

Healthcare ◽  
2021 ◽  
Vol 8 ◽  
pp. 100432
Author(s):  
Leah Tuzzio ◽  
Catherine M. Meyers ◽  
Laura M. Dember ◽  
Corita R. Grudzen ◽  
Edward R. Melnick ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Quality Improvement ◽  
Case Studies ◽  
Healthcare Systems ◽  
Pragmatic Clinical Trials

Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory

2021 ◽  
Author(s):  
Joseph Ali ◽  
Margaret Antonelli ◽  
Lori Bastian ◽  
William Becker ◽  
Cynthia A Brandt ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Pain Management ◽  
Pragmatic Trial ◽  
Dissemination And Implementation ◽  
Large Network ◽  
Military Health ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Pragmatic Clinical Trials ◽  
The Impact

ABSTRACT Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the “whole is greater than the sum of the parts.” Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, “real-world,” settings.

scholarly journals Integrated Health Systems and Integrated Knowledge: Creating Space for Putting Knowledge into Action

2009 ◽  
Vol 13 (sp) ◽  
pp. 30-36 ◽  
Author(s):  
Cathie Scott ◽  
Judy Seidel ◽  
Sarah Bowen ◽  
Nadine Gall
Keyword(s):  
Health Systems ◽  
Integrated Health ◽  
Integrated Knowledge

scholarly journals Effect of Medical Oncologists' Attitudes on Accrual to Clinical Trials in a Community Setting

2013 ◽  
Vol 9 (6) ◽  
pp. e275-e283 ◽  
Author(s):  
Carol P. Somkin ◽  
Lynn Ackerson ◽  
Gail Husson ◽  
Vicky Gomez ◽  
Tatjana Kolevska ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Delivery System ◽  
Community Setting ◽  
Health Delivery ◽  
Medical Oncologists ◽  
Integrated Health ◽  
Health Delivery System

In a large integrated health delivery system with an active clinical trials program, oncologists' participation in clinical trials was quite variable. Oncologist values, beliefs, and awareness of clinical trials play an important role in accrual.

scholarly journals Data monitoring committees for pragmatic clinical trials

2015 ◽  
Vol 12 (5) ◽  
pp. 530-536 ◽  
Author(s):  
Susan S Ellenberg ◽  
Richard Culbertson ◽  
Daniel L Gillen ◽  
Steven Goodman ◽  
Suzanne Schrandt ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Data Monitoring ◽  
Pragmatic Clinical Trials
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