June 22, 2018: Pragmatic Trial Design to Study Health Policy Interventions: Lessons Learned from ARTEMIS (Tracy Wang, MD, MHS, MSc)


Tracy Y. Wang, MD, MHS, MSc
Director, DCRI Health Service Research
Fellowship Associate Program Director
Associate Professor of Medicine, Cardiology
Duke University Medical Center


Pragmatic Trial Design to Study Health Policy Interventions: Lessons Learned from ARTEMIS


Clinical research; Pragmatic clinical trial; Pragmatic trial design; Health policy; ARTEMIS; Health policy; Health system; Cost-sharing models

Key Points

  • The ARTEMIS trial aims to improve patient outcomes by simulating health system and payer consideration of novel cost-sharing models.
  • Health policy and implementation studies require pragmatic trial design.
  • The ARTEMIS trial consists of 301 sites across the United States, with 23% classified as teaching hospitals.
  • Design and execution of the ARTEMIS trial prompted many questions, such as “Can we innovate the design of pragmatic health policy trials?”

Discussion Themes

As with most pragmatic clinical trials, the ARTEMIS trial is aimed at decision makers. However, in ARTEMIS, the “decision makers” are the healthcare systems, as well as the payers which is unusual as compared to most pragmatic clinical trials.

Variability in payment coverage contributed to the design of the ARTEMIS trial.

While the patient population in the ARTEMIS trial is analogous, the randomization of hospitals and the way in which the work of the hospitals is conducted is highly variable. Linking and data collection helped contribute to ARTEMIS findings.



@Collaboratory1, @TYWangMD, #pragmatictrial, #clinicaltrials, #pctGR, #EHR, @DCRnews

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