DCRI Executive Director Adrian Hernandez, MD, MHS, and co-authors recently published a commentary in the New England Journal of Medicine advocating for new ways to incentivize health care systems to participate in embedded pragmatic clinical trials and make research more efficient.
Embedding clinical research within health systems would, in theory, create a learning health system that enables more clinical trials to be conducted in a more efficient manner. However, to get to this point, the support and incentive systems for participating in research have to change, write the authors of a newly published commentary in the New England Journal of Medicine.
The commentary was authored by DCRI Executive Director Adrian Hernandez, MD, MHS, along with his co-authors Gregory Simon, MD, MPH, of the Kaiser Permanente Washington Health Research Institute and Richard Platt, MD, MSc, of the Harvard Pilgrim Health Care Institute. Both of these organizations, along with the DCRI, participate in and lead the NIH Health Care Systems Research Collaboratory, a testing ground for embedded pragmatic clinical trials that has “demonstrated the feasibility” of such studies, write the NEJM authors.
The COVID-19 pandemic has underscored the importance of rapid and efficient clinical research—and it has also created an opportunity to engage and support health care systems in new ways to encourage research participation, the authors write.
Traditionally, the aims of many needed comparative trials do not align directly with the goals of health care systems, meaning that there is less incentive for the systems to participate in the research. As the authors write, “Although the findings of these kinds of studies will eventually be important for clinicians and delivery systems, the incentive to participate is low because such studies provide no immediate benefit in terms of cost, quality metrics, or patients’ care experience.”
Other barriers that may be prohibitive to health care systems participating in embedded pragmatic clinical trials include higher costs associated with these studies and lack of research infrastructure. Patients and clinicians alike may be hesitant to participate in a study that involves randomization, while health system leaders may be concerned about liability issues.
Funders of research and other stakeholders in the research enterprise can do more to help eliminate or alleviate some of these barriers, the authors write, suggesting tactics that range from reimbursement of higher costs associated with research participation to centralizing bureaucratic research tasks through a coordinating center. Ultimately, the authors conclude, “Building stronger partnerships with delivery systems and increasing their willingness and ability to participate in trials addressing long-term goals will require changes to the way participation is supported and rewarded — changes that are achievable.”
To read about all of the authors’ recommended strategies for engaging with health care systems, see the full commentary in the New England Journal of Medicine.