ArticleLearning health systems2018
Opportunities and barriers for pragmatic embedded trials: Triumphs and tribulations.
Article in Learning health systems, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review of pragmatic randomised control trials assessing the effectiveness of professional pharmacy services in community pharmacies.BMC health services research · 2021Pooled it
- Trial-Based Economic Evaluations Conducted alongside Studies Embedded in Australian Healthcare Services and Programs: A Scoping Review.PharmacoEconomics - open · 2026Review
- A framework for health systems to assess and prioritize participation in pragmatic clinical trials.Learning health systems · 2025Article
- Pragmatic Comparative Effectiveness Trials in Rheumatoid Arthritis-Associated Interstitial Lung Disease: A Multiperspective Qualitative Study.CHEST pulmonary · 2025Article
- Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.Medical care · 2025Article
- Transforming the Effectiveness and Equity of a Psychological Therapy Service: A Case Study in the English NHS Talking Therapies Program.Administration and policy in mental health · 2024Article
- Adopting the principles and practices of learning health systems in universities and colleges: recommendations for delivering actionable data to improve student mental health.Cogent mental health · 2024Article
- Embedding clinical trial elements into clinical practice: Experiences from trial designers and implementers.Journal of clinical and translational science · 2024Article
- Article
- Evolving a national clinical trials learning health system.Learning health systems · 2023Article
- An analysis of published trials found that current use of pragmatic trial labels is uninformative.Journal of clinical epidemiology · 2022Review
- Informed consent in pragmatic trials: results from a survey of trials published 2014-2019.Journal of medical ethics · 2021Article
- Article
- A review of pragmatic trials found a high degree of diversity in design and scope, deficiencies in reporting and trial registry data, and poor indexing.Journal of clinical epidemiology · 2021Review
- Article
- Opportunities and barriers for pragmatic embedded trials: Triumphs and tribulations.Learning health systems · 2018Article
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
resultsEmbedded pragmatic clinical trials (PCTs) are set in routine health care, have broad eligibility criteria, and use routinely collected electronic data. Many consider them a breakthrough innovation in clinical research and a necessary step in clinical trial development. To identify barriers and success factors, we reviewed published embedded PCTs and interviewed 30 researchers and clinical leaders in 7 US delivery systems. LITERATURE: We searched PubMed, the Cochrane library, and clinicaltrials.gov for studies reporting embedded PCTs. We identified 108 embedded PCTs published in the last 10 years. The included studies had a median of 5540 randomized patients, addressed a variety of diseases, and practice settings covering a broad range of interventions. Eighty-one used cluster randomization. The median cost per patient was $97 in the 64 trials for which it was possible to obtain cost data. INTERVIEWS: Delivery systems required research studies to align with operational priorities, existing information technology capabilities, and standard quality improvement procedures. Barriers that were identified included research governance, requirements for processes that were incompatible with clinical operations, and unrecoverable costs.
conclusionsEmbedding PCTs in delivery systems can provide generalizable knowledge that is directly applicable to practice settings at much lower cost than conventional trials. Successful embedding trials require accommodating delivery systems' needs and priorities.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.