دورية أكاديمية
Factors Affecting Post-trial Sustainment or De-implementation of Study Interventions: A Narrative Review.
| العنوان: | Factors Affecting Post-trial Sustainment or De-implementation of Study Interventions: A Narrative Review. |
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| المؤلفون: | Green T; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA., Bosworth HB; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.; Department of Population Health Sciences, Duke University School of Medicine, Duke University, 215 Morris St., Suite 210, Durham, NC, 27708, USA.; Department of Medicine, Duke University School of Medicine, Duke University, Durham, NC, USA.; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA., Coronado GD; Kaiser Permanente Center for Health Research, Portland, OR, USA., DeBar L; Kaiser Permanente Center for Health Research, Portland, OR, USA., Green BB; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA., Huang SS; Irvine School of Medicine, University of California, Irvine, CA, USA., Jarvik JG; Department of Radiology, University of Washington School of Medicine, University of Washington, Seattle, WA, USA., Mor V; Department of Health Services, Policy, and Practice, School of Public Health, Brown University and Providence Veterans Administration Medical Center, Providence, RI, USA., Zatzick D; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, University of Washington, Seattle, WA, USA., Weinfurt KP; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.; Department of Population Health Sciences, Duke University School of Medicine, Duke University, 215 Morris St., Suite 210, Durham, NC, 27708, USA., Check DK; Department of Population Health Sciences, Duke University School of Medicine, Duke University, 215 Morris St., Suite 210, Durham, NC, 27708, USA. devon.check@duke.edu. |
| المصدر: | Journal of general internal medicine [J Gen Intern Med] 2024 May; Vol. 39 (6), pp. 1029-1036. Date of Electronic Publication: 2024 Jan 12. |
| نوع المنشور: | Journal Article; Review; Research Support, N.I.H., Extramural |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: United States NLM ID: 8605834 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1525-1497 (Electronic) Linking ISSN: 08848734 NLM ISO Abbreviation: J Gen Intern Med Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Secaucus, NJ : Springer Original Publication: [Philadelphia, PA] : Hanley & Belfus, [c1986- |
| مواضيع طبية MeSH: | Pragmatic Clinical Trials as Topic*/methods, Humans ; United States |
| مستخلص: | In contrast to traditional randomized controlled trials, embedded pragmatic clinical trials (ePCTs) are conducted within healthcare settings with real-world patient populations. ePCTs are intentionally designed to align with health system priorities leveraging existing healthcare system infrastructure and resources to ease intervention implementation and increase the likelihood that effective interventions translate into routine practice following the trial. The NIH Pragmatic Trials Collaboratory, funded by the National Institutes of Health (NIH), supports the conduct of large-scale ePCT Demonstration Projects that address major public health issues within healthcare systems. The Collaboratory has a unique opportunity to draw on the Demonstration Project experiences to generate lessons learned related to ePCTs and the dissemination and implementation of interventions tested in ePCTs. In this article, we use case studies from six completed Demonstration Projects to summarize the Collaboratory's experience with post-trial interpretation of results, and implications for sustainment (or de-implementation) of tested interventions. We highlight three key lessons learned. First, ineffective interventions (i.e., ePCT is null for the primary outcome) may be sustained if they have other measured benefits (e.g., secondary outcome or subgroup) or even perceived benefits (e.g., staff like the intervention). Second, effective interventions-even those solicited by the health system and/or designed with significant health system partner buy-in-may not be sustained if they require significant resources. Third, alignment with policy incentives is essential for achieving sustainment and scale-up of effective interventions. Our experiences point to several recommendations to aid in considering post-trial sustainment or de-implementation of interventions tested in ePCTs: (1) include secondary outcome measures that are salient to health system partners; (2) collect all appropriate data to allow for post hoc analysis of subgroups; (3) collect experience data from clinicians and staff; (4) engage policy-makers before starting the trial. (© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.) |
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| معلومات مُعتمدة: | U24 AT010961 United States AT NCCIH NIH HHS; U24AT009676 United States NH NIH HHS; U24AT010961 United States NH NIH HHS |
| فهرسة مساهمة: | Keywords: de-implementation; embedded pragmatic clinical trials; implementation; post-trial decisions |
| تواريخ الأحداث: | Date Created: 20240112 Date Completed: 20240506 Latest Revision: 20240726 |
| رمز التحديث: | 20240726 |
| مُعرف محوري في PubMed: | PMC11074060 |
| DOI: | 10.1007/s11606-023-08593-7 |
| PMID: | 38216853 |
| قاعدة البيانات: | MEDLINE |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 1525-1497 |
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| DOI: | 10.1007/s11606-023-08593-7 |