Kathleen Unroe, M.D., MPH, M.S., explains how pragmatic trials embed proven interventions into real-world clinical workflows to ensure they are practical and scalable.
Transcript:
Once we know that something works, we have evidence of efficacy. However, then we move into the real world. This is where pragmatic trials come in. Pragmatic trials recognize that delivery of interventions has to occur in real-world settings. You need to work with what exists in the electronic medical record or something that you can build into the clinical workflows, because you need your evaluation plan within the pragmatic trial to mirror the kind of evaluation that you would do in the real world to make sure a program’s up and running and functioning. We need to work within the structures — the staff and the resources of the facility — that make sense within the existing clinical workflows. Pragmatic design means you understand the existing clinical environment deeply, and you’re embedding within it in a way that will be generalizable and replicable.
Dr. Unroe describes how the APPROACHES trial equips nursing home staff with training, tools and workflows to deliver consistent, high-quality advance care planning.
Transcript:
While advance care planning is seen as a standard of care, it has been challenging to do time-intensive, high-quality, consistent advance care planning across the board in nursing homes. The APPROACHES trial created an online training program for staff in the buildings who are already tasked with having these conversations. So our goal was to increase their baseline knowledge around advance care planning and give them practical skills to put into practice as well as structure for doing advance care planning. We also worked with the electronic medical record systems of the nursing homes where we were partnered to create new documentation templates for advance care planning, because there is nothing more frustrating to a nursing home resident and his or her family member to have had this great conversation where decisions are made and then in a moment of medical crisis, no one can find that information. So we also supported with workflows around consistent, easy-to-find documentation. So APPROACHES is training staff in the facility to do this work and also creating structure and support for them to roll out an advance care planning program in their facility.
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