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NIH Collaboratory
Living Textbook of
Pragmatic Clinical Trials

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Rethinking Clinical Trials

A Living Textbook of Pragmatic Clinical Trials

  • Design
    • What is a Pragmatic Clinical Trial?
    • Decentralized Pragmatic Clinical Trials
    • Developing a Compelling Grant Application
    • Experimental Designs and Randomization Schemes
    • Endpoints and Outcomes
    • Analysis Plan
    • Using Electronic Health Record Data
    • Building Partnerships and Teams to Ensure a Successful Trial
    • Intervention Delivery and Complexity
    • Patient Engagement
  • Data, Tools & Conduct
    • Assessing Feasibility
    • Acquiring Real-World Data
    • Assessing Fitness-for-Use of Real-World Data
    • Study Startup
    • Participant Recruitment
    • Monitoring Intervention Fidelity and Adaptations
    • Patient-Reported Outcomes
    • Clinical Decision Support
    • Mobile Health
    • Electronic Health Records–Based Phenotyping
    • Navigating the Unknown
  • Dissemination & Implementation
    • Data Sharing and Embedded Research
    • Dissemination Approaches for Different Audiences
    • Implementation
    • End-of-Trial Decision-Making
  • Ethics & Regulatory
    • Privacy Considerations
    • Identifying Those Engaged in Research
    • Collateral Findings
    • Consent, Disclosure, and Non-Disclosure
    • Data and Safety Monitoring
    • Ethical Considerations of Data Sharing in Pragmatic Clinical Trials
    • Ethics for AI and ML
    • IRB Responsibilities and Procedures

Additional Resources

CHAPTER SECTIONS

What is a Pragmatic Clinical Trial?


Section 7

Additional Resources

Expand Contributors

Emily C. O’Brien, PhD
Kevin P. Weinfurt, PhD

Contributing Editor
Damon M. Seils, MA

Training Resources for Embedded PCTs

The NIH Pragmatic Trials Collaboratory offers practical resources for investigators interested in learning to design, conduct, and disseminate pragmatic clinical trials embedded in healthcare systems. It includes presentations, videos, workshops, and guidance on how to build partnerships with healthcare systems and overcome the challenges of conducting embedded pragmatic research. Visit the Training Resources page to explore these materials.

Rethinking Clinical Trials Grand Rounds and Podcast

An ongoing resource from the NIH Collaboratory is the Rethinking Clinical Trials Grand Rounds webinar series held every Friday at 1:00 pm eastern time. These hour-long webinars with Q&A are presented by experts on a wide range of topics related to pragmatic research. Find all the webinars and related slides in the archive.

The Rethinking Clinical Trials Podcast provides a platform for discussions about interesting and timely issues in the field of pragmatic clinical trials. Featured guests include Grand Rounds speakers, representatives from the NIH Collaboratory Trials, and thought leaders from the NIH Collaboratory and the broader research community.

A special Rethinking Clinical Trials Grand Rounds series on content from the Living Textbook explores key aspects of planning and conducting embedded pragmatic trials, beginning with “Pragmatic Clinical Trials: How Do I Start?” View the webinar below and download the slides.

Table of Contents

In this textbook, we collect information provided by the Core Working Groups, the NIH Collaboratory Trials, and the literature to explore considerations for designing, conducting, and disseminating embedded pragmatic trials. We invite you to navigate through each section sequentially or use the navigation menu to select a topic of interest. A site map in the form of Table of Contents is also available.

Other Resources

Resource Description
Lessons from the NIH Pragmatic Trials Collaboratory
  • Monitoring in pragmatic trials: Lessons from the NIH Pragmatic Trials Collaboratory (2025)
  • Impact of electronic health record updates and changes on the delivery and monitoring of interventions in embedded pragmatic clinical trials (2025)
  • Collection of patient-reported outcome measures in rural and underserved populations (2025)
  • Factors affecting post-trial sustainment or de-implementation of study interventions: A narrative review (2024)
  • Collecting patient-reported outcome measures in the electronic health record: Lessons from the NIH pragmatic trials Collaboratory (2024)
  • Pragmatic guidance for embedding pragmatic clinical trials in health plans: Large simple trials aren't so simple (2023)
  • The impact of COVID-19 on pragmatic clinical trials: Lessons learned from the NIH Health Care Systems Research Collaboratory (2022)
  • Enhancing the use of EHR systems for pragmatic embedded research: Lessons from the NIH Health Care Systems Research Collaboratory (2021)
  • Pragmatic clinical trials offer unique opportunities for disseminating, implementing, and sustaining evidence-based practices into clinical care: Proceedings of a workshop (2019)
  • Pragmatic clinical trials embedded in healthcare systems: Generalizable lessons from the NIH Collaboratory (2017)
  • Statistical lessons learned for designing cluster randomized pragmatic clinical trials from the NIH Health Care Systems Collaboratory Biostatistics and Design Core (2016)
Lessons from the NIA IMPACT Collaboratory
  • Pragmatic clinical trials for dementia care: Experience from the first 5 years of the IMPACT Collaboratory (2024)
  • Best practice recommendations for integrating health equity into pragmatic clinical trials for dementia care (2024)
  • The NIA IMPACT Collaboratory: History, impact, challenges, and the future of conducting ePCTs to improve dementia care (2024)
  • Selecting outcomes for pragmatic clinical trials in dementia care: The IMPACT Collaboratory iLibrary (2024)
  • Development of a lived experience panel to inform the design of embedded pragmatic trials of dementia care interventions (2024)
  • Using hybrid effectiveness studies to facilitate implementation in community-based settings: Three case studies in dementia care research (2024)
  • Selecting outcomes to ensure pragmatic trials are relevant to people living with dementia (2020)
  • Engaging stakeholders in the design and conduct of embedded pragmatic clinical trials for Alzheimer's disease and Alzheimer's disease-related dementias (2020)
  • Using healthcare data in embedded pragmatic clinical trials among people living with dementia and their caregivers: State of the art (2020)
  • Ethical and regulatory issues for embedded pragmatic trials involving people living with dementia (2020)
Lessons from the NIH-DoD-VA Pain Management Collaboratory
  • Strategies for working with pragmatic clinical trial observational data-lessons learned from the Pain Management Collaboratory (2024)
  • Utility of the PICOTS framework to assess clinical trial disruptions: Monitoring the impact of COVID-19 in the Pain Management Collaboratory (2024)
  • Engaging clinical partners in pragmatic clinical trials: Lessons learned from the Pain Management Collaboratory (2024)
  • Optimizing the impact of pragmatic clinical trials for veteran and military populations: Lessons From the Pain Management Collaboratory (2022)
  • Designing trials with purpose: pragmatic clinical trials of nonpharmacological approaches for pain management (2020)
  • Strategy for addressing research-site overlap in pragmatic clinical trials: Lessons learned from the NIH-DOD-VA Pain Management Collaboratory (PMC) (2020)
Ethical challenges of research on usual care
  • Bystander ethics and good samaritanism: A paradox for learning health organizations (2019)
  • Ostriches and obligations: Ethical challenges facing research on usual care (2019)
Lessons from IMPACT-AFib, an FDA-Catalyst trial Practical challenges in the conduct of pragmatic trials embedded in health plans: Lessons of IMPACT-AFib, an FDA-Catalyst trial (2020)
Ethical and regulatory issues in pragmatic clinical trials This special issue of Clinical Trials provides background for and links to a series of 12 articles on the ethics and regulatory challenges in pragmatic clinical trials. Each article in this special issue of Clinical Trials describes an issue in detail and, where possible, offers guidance for future pragmatic clinical trials.
Determining Real-World Data’s Fitness for Use and the Role of Reliability This white paper from the Duke-Margolis Center for Health Policy describes how real-world data can generate real-world evidence that more efficiently evaluates the potential benefits or risks of medical products, is more inclusive of broader patient populations, and more reflective of routine clinical and patient self-care.
Research Methods Resources website The NIH Office of Extramural Research has released new clinical trial requirements for grant applications and contract proposals due on or after January 25, 2018. In anticipation of these requirements, the NIH modified the Application Guide and the Review Criteria to address methodological problems common to many clinical trials. As cluster randomized designs are increasingly common in both basic and applied research, the new Application Guide includes links to the new Research Methods Resources website, which provides resources for investigators considering these cluster randomized designs, including lists of NIH webinars, key references, and statements to help investigators prepare sound applications and avoid methodological pitfalls.

Previous Section

SECTIONS

CHAPTER SECTIONS

sections

  1. Why Are We Talking About Pragmatic Trials?
  2. The Embedded Pragmatic Clinical Trial Ecosystem
  3. Differentiating Between Research and Quality Improvement Activities
  4. Pragmatic Elements: An Introduction to PRECIS-2
  5. PRECIS-2 Case Study
  6. Key Considerations for Pragmatic Trials
  7. Additional Resources

ACKNOWLEDGMENTS

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Contributing editors of previous versions of this chapter include Jonathan McCall, Karen Staman, and Liz Wing of the NIH Pragmatic Trials Collaboratory Coordinating Center.

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Version History

Published July 31, 2025

current section :

Additional Resources

  1. Why Are We Talking About Pragmatic Trials?
  2. The Embedded Pragmatic Clinical Trial Ecosystem
  3. Differentiating Between Research and Quality Improvement Activities
  4. Pragmatic Elements: An Introduction to PRECIS-2
  5. PRECIS-2 Case Study
  6. Key Considerations for Pragmatic Trials
  7. Additional Resources

Citation:

O'Brien EC, Weinfurt KP. What is a Pragmatic Clinical Trial?: Additional Resources. In: Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials. Bethesda, MD: NIH Pragmatic Trials Collaboratory. Available at: https://rethinkingclinicaltrials.org/chapters/design/what-is-a-pragmatic-clinical-trial/additional-pct-resourcesv2/. Updated December 3, 2025. DOI: 10.28929/273.

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