Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials
Welcome to the Living Textbook of pragmatic clinical trials, a collection of knowledge from the NIH Pragmatic Trials Collaboratory. Pragmatic clinical trials present an opportunity to efficiently generate high-quality evidence to inform medical decision-making. However, these trials pose different challenges than traditional clinical trials. The Living Textbook reflects a collection of special considerations and best practices in the design, conduct, and reporting of pragmatic clinical trials.
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What is the
NIH Pragmatic Trials Collaboratory?
What is a
pragmatic clinical trial?
Training Resources
Featured
November Workshop Materials Now Available
On November 4 and 5, 2025, the NIH Pragmatic Trials Collaboratory hosted a virtual workshop "Digging Into Dilemmas of Pragmatic Clinical Trials." David Zaas, president of Atrium Health Wake Forest Baptist, delivered a keynote presentation describing the state of healthcare delivery in the United States and constraints on healthcare systems.
View the presentation slides and recordings.
Don't Miss All-New Episodes of the NIH Pragmatic Trials Collaboratory Podcast
The NIH Pragmatic Trials Collaboratory Podcast broadcasts engaging discussions on timely issues in the field of pragmatic clinical trials. Tune in monthly for fresh insights from Grand Rounds speakers, representatives from NIH Collaboratory Trials, and thought leaders within the NIH Collaboratory and broader research community.
Subscribe for free on Spotify, Amazon Music, Apple Podcasts, or SoundCloud.
NIH COLLABORATORY TRIALS
Pragmatic clinical trials that address questions of major public health importance and provide proof of concept for innovative pragmatic research designs.
CORES
Working groups that support the conduct of NIH Collaboratory Trials and generate guidance addressing implementation challenges.
DISTRIBUTED RESEARCH NETWORK
Network enabling investigators to collaborate in the use of electronic health data while safeguarding protected health information.
Upcoming Learning Opportunities
Grand Rounds March 6, 2026: Bringing Primary Care Clinical Trials Research Into the 21st Century: Lessons Learned and Developments From Large-Scale European Adaptive Platform Trials of Therapeutics for Acute Respiratory Infections (Christopher C. Butler, BA, MBChB, DCH, CCH, MD, FRCGP)
March 6 @ 1:00 pm - 2:00 pmGrand Rounds March 13, 2026: Behavioral Economics and Medication Adherence for Hypertension: A Randomized Clinical Trial (John A. Dodson, MD, MPH)
March 13 @ 1:00 pm - 2:00 pmGrand Rounds March 20, 2026: FLUID: A Cross-Over Trial of Hospital Wide Ringer’s Lactate vs Normal Saline (Lauralyn McIntyre, MD, FRCPC, MSc; Monica Taljaard, PhD)
March 20 @ 1:00 pm - 2:00 pmGrand Rounds March 27, 2026: Text Messaging and Video Stories to Support Hypertension Self-Management in Black Veterans: A Randomized Clinical Trial (Sarah L. Cutrona, MD, MPH)
March 27 @ 1:00 pm - 2:00 pm
NEWS
- February 25, 2026: Optimal Transfusion Strategy in High Cardiac Risk Patients, in This Week’s Rethinking Clinical Trials Grand RoundsIn this Friday’s Rethinking Clinical Trials Grand Rounds, Panos Kougias and Sherene Sharath of SUNY Downstate Health Sciences University will present “Optimal Transfusion Strategy in High Cardiac Risk Patients After ...
- February 24, 2026: Pragmatic Clinical Trials Offer Unique Opportunities to Study Implementation Processes and OutcomesThe interventions tested in pragmatic clinical trials are embedded into routine care practices, which offers opportunities to study implementation and sustainment outcomes. In an article published online ahead of print in ...
- February 23, 2026: New Podcast Episode Outlines Guidance for Monitoring in Decentralized TrialsIn a new episode of the NIH Collaboratory Podcast, Drs. Christopher Lindsell and Adrian Hernandez discussed the need for virtual vigilance in decentralized trials. Listen to the podcast. For alerts about ...