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

Cari Levy, Sheryl Zimmerman, Vincent Mor, David Gifford, Sherry A. Greenberg, Juliet Holt Klinger, Cathy Lieblich, Sunny Linnebur, Angie McAllister, Arif Nazir, Douglas Pace, Robyn Stone, Barbara Resnick, Philip D. Sloane, Joseph Ouslander, Joseph E. Gaugler

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.

Original languageEnglish (US)
Pages (from-to)339-344
Number of pages6
JournalJournal of the American Medical Directors Association
Issue number3
StatePublished - Mar 2022

Bibliographical note

Funding Information:
This work was supported by the National Institute on Aging (NIA) of the National Institutes of Health under Award Number R13AG067681 . Sheryl Zimmerman, Vincent Mor, and Joseph Gaugler were also supported by the NIA under Award Number U54AG063546, which funds the NIA Imbedded Pragmatic Alzheimer's Disease and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021


  • Pragmatic trials
  • dissemination
  • implementation
  • Nursing Homes
  • Humans
  • Long-Term Care
  • Stakeholder Participation

PubMed: MeSH publication types

  • Pragmatic Clinical Trial
  • Journal Article
  • Research Support, N.I.H., Extramural


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