Here is the standardised PICO analysis for the twenty-eighth uploaded article:
Full Title
Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities
Authors: Cari Levy, Sheryl Zimmerman, Vincent Mor, et al.
Journal: Journal of the American Geriatrics Society, 2022; 70(3):709–717
DOI: 10.1111/jgs.17698
Type of Study
Consensus and expert commentary paper based on a 2021 National Institute on Aging-funded conference
PICO Summary
Population (P)
- Stakeholders in long-term care (LTC) settings, including:
- Researchers
- Policymakers
- Clinicians and administrators
- Direct care workers
- Residents and families
- Focus on environments such as nursing homes and assisted living facilities
Intervention (I)
- Design, implementation, and dissemination of pragmatic trials in long-term care
- Key strategies discussed:
- Stakeholder engagement
- Inclusion and diversity
- Organisational readiness
- Learning from adaptations
- Integration into existing workflows
- Agile funding and implementation structures
Comparison (C)
- Not a comparative study; commentary contrasts pragmatic trials with traditional RCTs and offers strategies for improving real-world applicability
Outcomes (O)
System-level/process outcomes:
- Improved implementation fidelity and trial scalability through:
- Tailored dissemination strategies
- Workflow compatibility
- Utilisation of local champions and facilitators
- Bidirectional communication between researchers and LTC providers
Operational impacts:
- Lessons drawn from past pragmatic trials (e.g. INTERACT, PROVEN) on challenges with:
- Staff turnover
- Lack of executive buy-in
- Documentation burdens
- Inequitable diffusion of innovations (resource-rich homes more likely to adopt)
Recommendations for future outcomes:
- Use of dissemination frameworks and toolkits
- Integration of learning health system principles
- Monitoring of fidelity and adaptations
- Prioritisation of implementation research alongside clinical outcomes
Findings Summary
This article presents insights from a national consensus panel on conducting pragmatic trials in LTC. It identifies critical gaps in stakeholder engagement, inclusivity, and translation of research into practice. The authors call for:
- Systematic integration of implementation science
- Adaptable, responsive funding mechanisms
- Active involvement of residents, families, and frontline staff
- Use of dissemination platforms like the VA Diffusion Marketplace to scale innovations
The article does not test a specific intervention but acts as a methodological roadmap for improving the design, dissemination, and implementation of complex interventions in LTC environments .
Life In The Slower Lane 
Leave a comment