Implementation and Conduct of Pragmatic Trials

Implementation and implementation research are integral to pragmatic research and the ability of pragmatic trials to achieve their goals. This presentation reviews wide-ranging implications of this assertion, discussing the ways in which pragmatic research and pragmatic researchers must account for implementation phenomena and implementation goals in study design, conduct and follow-up. The need to attend to implementation ranges from the dependence of intervention effectiveness on implementation patterns and processes (and hence the need to explicitly consider implementation in formulating research questions and study designs) to the critical role of implementation in facilitating intervention use and, therefore, achievement of intervention and pragmatic research goals. The presentation discusses how frameworks and approaches from diverse fields can inform appropriate consideration of implementation in pragmatic research, including fields such as improvement science, learning health systems, systems thinking and the study of complex health interventions.

LEARNING OBJECTIVES

1. Examine and understand fundamental goals of pragmatic research and how these goals lead to recognition of the importance of implementation and use of implementation research.
2. Derive key implications of the central role of implementation in pragmatic research, including implications for study questions, designs, conduct and follow-up.
3. Learn core principles and insights from improvement science, learning health systems, embedded research, systems thinking and complex health interventions.
4. Apply these principles and insights to the design and conduct of pragmatic research to maximize research success and impacts.
5. Identify key barriers to broader incorporation of implementation and implementation research in pragmatic research and identify strategies to overcome these barriers.