Pragmatic trials in long-term care: Challenges, opportunities, recommendations

Area of Science:

• Health Services Research
• Gerontology
• Clinical Trials Methodology

Background:

• Randomized controlled trials (RCTs) face real-world applicability challenges.
• Pragmatic trials offer a more reproducible research design for complex settings.
• Long-term care settings increasingly adopt pragmatic methodology for better dissemination and implementation.

Purpose of the Study:

• To provide expert recommendations for disseminating and implementing pragmatic trial interventions in long-term care.
• To address complexities inherent in pragmatic trial methodology within long-term care.

Main Methods:

• A virtual consensus conference was convened with experts in pragmatic trials, nursing home policy, advocacy, and clinical care.
• Participants were funded by the National Institute on Aging in Spring 2021.
• Recommendations were developed through expert consensus.

Main Results:

• Four cross-cutting principles for dissemination and implementation: stakeholder engagement, diversity and inclusion, organizational readiness assessment, and learning from adaptations.
• Two implementation-specific recommendations: integrating interventions into workflows and maintaining agility.
• Three dissemination-specific recommendations: tailoring messages, engaging diverse audiences, and using dissemination tools.

Conclusions:

• Implementation must consider the perspectives of those responsible for intervention delivery.
• Dissemination messaging should resonate with long-term care staff and stakeholders.
• This guidance aims to support researchers and providers in implementing evidence-based interventions pragmatically.