Stepped-Wedge Designs

Designing with Implementation and Dissemination in Mind

Section 4

Stepped-Wedge Designs


David Chambers, DPhil

Gloria Coronado, PhD

Beverly Green, MD, MPH

Jeffrey Jarvik, MD, MPH

Edward J Septimus, MD, FACP

Leah Tuzzio, MPH

Douglas Zatzick, MD


Contributing Editor

Karen Staman, MS

With a stepped wedge design, in which, over time, the intervention is turned “on” in all participating sites (Hughes et al. 2015), one might expect that implementation at participating sites would be fairly seamless; if the intervention is working, sites can simply leave it turned on. However, there is a question of timing—does one turn off the intervention while waiting for results or leave it on? And, based on the experiences of the Collaboratory, there is ample variation among sites and individuals regarding the fidelity to an intervention.

In the chapter on Dissemination and Implementation, we describe a case example from the Lumbar Imaging with Reporting of Epidemiology (LIRE) trial.




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Hughes JP, Granston TS, Heagerty PJ. 2015. Current issues in the design and analysis of stepped wedge trials. Contemp Clin Trials. 45:55–60. doi:10.1016/j.cct.2015.07.006. PMID:26247569.

Version History

Published August 25, 2017

current section :

Stepped-Wedge Designs


Chambers D, Coronado G, Green B, et al. Designing with Implementation and Dissemination in Mind: Stepped-Wedge Designs. In: Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials. Bethesda, MD: NIH Health Care Systems Research Collaboratory. Available at: Updated November 13, 2018. DOI: 10.28929/052.