Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities

Area of Science:

• Gerontology
• Health Services Research
• Clinical Trials Methodology

Background:

• Randomized controlled trials (RCTs) face challenges in real-world settings, limiting applicability.
• Pragmatic trials offer a solution by increasing reproducibility and real-world relevance.
• Long-term care settings increasingly adopt pragmatic methodology for better dissemination and implementation.

Purpose of the Study:

• To identify key principles for disseminating and implementing pragmatic trial interventions in long-term care.
• To address complexities associated with pragmatic trials in this setting.
• To guide researchers and providers in applying evidence-based interventions.

Main Methods:

• A virtual consensus conference was conducted in Spring 2021, funded by the National Institute on Aging.
• Participants included experts in pragmatic trials, nursing home policy, advocacy, and clinical care.
• The conference focused on identifying cross-cutting principles for pragmatic trial implementation.

Main Results:

• Four cross-cutting principles were identified: stakeholder engagement, diversity and inclusion, organizational strain and readiness, and learning from adaptations.
• Emphasis was placed on grounding implementation in the perspectives of those responsible for it.
• Messaging should resonate with long-term care staff and stakeholders.

Conclusions:

• Effective dissemination and implementation of pragmatic trial interventions require a focus on stakeholder perspectives and organizational context.
• Addressing diversity, readiness, and adaptability is crucial for successful integration into long-term care.
• This work provides guidance for improving the application of evidence-based care in long-term settings.