The Promise of Pragmatic Clinical Trials Embedded in Learning Health Systems

This commentary describes the need for a different context to clinical research that could speed the discovery and implementation of evidence-based advancements to health care delivery. Pragmatic clinical trials (PCTs) are a promising type of trial conducted within real-world health care delivery systems like organizations within the Health Care Systems Research Network, that embrace research as part of their culture of continuous learning and improvement. In these learning health systems (LHSs) clinical practice influences research and vice versa. A goal of LHSs is to operationalize evidence generated by research, particularly PCTs, into improvements that are sustained after a trial ends. PCTs that demonstrate value to health systems and foster implementation could reduce delays in translating research into practice.