Pragmatic Randomized Clinical Trials Using Primary Data Collection and Electronic Health Records addresses the practical aspects and challenges of the design, implementation, and dissemination of pragmatic randomized trials, also sometimes referred to as practical or hybrid randomized trials. While less restrictive and more generalizable than traditional randomized controlled trials, such trials have specific challenges which are addressed in this book. The book contains chapters encompassing common designs along with advantages and limitations of such designs, analytic aspects in planning trials and estimating sample size, and how to use patient partners to help design and operationalize pragmatic randomized trials. Pragmatic trials conducted using primary data collection and trials embedded in electronic health records - including electronic medical records and administrative insurance claims - are addressed.This comprehensive resource is valuable not only for pharmacoepidemiologists, biostatisticians and clinical researchers, but also across the biomedical field for those who are interested in applying pragmatic randomized clinical trials in their research.
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Table of Contents
Acknowledgements Preface Robert Califf and Joe SelbyI: Introduction 1. Introduction to pRCTs Cynthia J. Girman and Mary Elizabeth Ritchey 2. The Efficacy-Effectiveness Gap Rolf H.H. Groenwold 3. Studies for labeling vs reimbursement Robert EpsteinII: Patient Voice and Stakeholder Feedback 4. Stakeholder Engagement in pRCT Design and Conduct Thomas Concannon 5. Patient Voice in Clinical Trial Programs in Industry Jeanne M. RegnanteIII: Design & Analysis 6. What is the research question? Elizabeth A. Suarez and Soko Setoguchi 7. Feasibility assessment for use of EHR Mary Elizabeth Ritchey 8. Important design considerations in pRCTs Kevin Thorpe 9. Randomization and Blinding
Randomization at what unit? Blinding of who and what? Jennifer Christian 10. Cluster Randomized Trials Katherine Harris 11. Design and Analytic Approaches to Minimize Bias and Confounding Michele Jonsson Funk 12. Sensitivity analyses Elizabeth A. Suarez and Cynthia J. Girman 13. Methodology and Reporting Guidelines Aisling Caffrey 14. Unmeasured Confounding with and without randomization Phyo Than Htoo and Til SturmerIV: Operational Aspects 15. Validation of Electronic Health Record and Patient-Reported Outcomes Vincent Lo Re III 16. Special Considerations in EHR Leah McGrath and Jenna Wong 17. Distributed Networks of Electronic Health Record Data Catherine A. Panozzo 18. International and global issues
differences in medical practice Ju-Young (Judy) Shin, Kenneth Man and Wei ZhouV: Privacy and Ethics 19. Considerations for Protecting Research Participants Aisling CaffreyVI: Interpretation, Limitations, and Strengths 20. Replication and reproducibility Kristy Iglay and Mary Elizabeth RitcheyVII: Dissemination 21. Communicating results to patients for shared decision-making Wendy Camelo Castillo 22. Communicating Results of pRCTs to the Medical Community Joe Selby and Timothy Carey 23. Communicating to regulatory agencies Larry D. AlphsVIII: Special Considerations on Interventions 24. Biologics Jaclyn L. F. Bosco and Priscilla Velentgas 25. Medical Devices Mary Elizabeth Ritchey 26. Rare Diseases Cunlin Wang and Lina Titievsky 27. Behavioral Interventions Andrea TroxelIX: Case Studies 28. Examples from Primary Data Collection Kourtney J. Davis and Jeanne Marie Pimenta 29. Examples from Electronic Health Records and Administrative Claims Data Ehab Hasan 30. Use of Pragmatic Randomized Clinical Trials in Reimbursement Decisions Kati Copley-MerrimanX: Conclusions 31. Concluding remarks Cynthia J. Girman, Mary Elizabeth Ritchey and Elizabeth A. Suarez
Authors
Cynthia J. Girman Founder and President; Real World Evidence, Pharmacoepidemiology and Patient Outcomes; CERobs Consulting, LLC; Wrightsville Beach, NC USA.
Cynthia Girman, DrPH, FISPE, is founder and President of CERobs Consulting, LLC, which provides consulting services to the pharmaceutical and healthcare industry on study design and scientific methods for real world observational studies, comparative effectiveness research and pragmatic randomized clinical trials. Dr. Girman is a seasoned epidemiologist with strong interest in biostatistical and observational methods, and the bulk of her 40+ year career has been in the pharmaceutical industry. Her undergraduate and doctoral training was at UNC and her MS in Applied Statistics and Computer Science is from Villanova University. She has led multi-institution academic collaborations, published extensively and reviewed for numerous peer-reviewed medical journals. As Adjunct Professor of Epidemiology at the University of North Carolina (UNC) Gillings School of Global Public Health, she collaborates on methodology research, gives guest classroom lectures and mentors numerous doctoral candidate graduate research assistants and post-doctoral fellows. Dr. Girman was an elected Board member 2015-2020 and is a fellow of the International Society for Pharmacoepidemiology (ISPE) and she annually teaches in the pragmatic randomized clinical trials (pRCT) pre-conference course. In September 2014, Dr. Girman was the first industry member nominated to the Patient-Centered Outcomes Research Institute (PCORI) Methodology Committee, on which she actively contributes along with their Clinical Trials Advisory Panel. Currently, Dr. Girman consults on study design, protocol development and analytic methods for real world evidence, such as registries, post-authorization safety studies, natural history studies, comparative effectiveness research, pragmatic randomized clinical trials, and external control groups for rare diseases. She also consults on endpoint strategies for randomized clinical trials, including patient reported outcomes, clinician assessments and expert review panels, as well as patient engagement and qualitative research.
Mary E. Ritchey Principal and Owner, Med Tech Epi, LLC, Philadelphia, PA USA; Associate Research Professor, Center for Pharmacoepidemiology and Treatment Sciences, Rutgers University, New Brunswick, NJ USA; Senior Executive Pharmacoepidemiologist, Real World Evidence, Pharmacoepidemiology and Patient Outcomes, CERobs Consulting, LLC; Wrightsville Beach, NC USAPrincipal and Owner, Med Tech Epi, LLC, Philadelphia, PA USA; Associate Research Professor, Center for Pharmacoepidemiology and Treatment Sciences, Rutge.
Mary E Ritchey, PhD, FISPE is Principal and Owner, Med Tech Epi, LLC a consulting group which provides real-world evidence strategy development, study design and implementation for medical devices, biotech, and medicines. She is an Associate Research Professor in the Center for Pharmacoepidemiology and Treatment Sciences at Rutgers University and a Senior Executive Pharmacoepidemiologist for CERobs Consulting, LLC. Dr. Ritchey obtained her masters and doctorate degrees in epidemiology from University of North Carolina Gillings School of Global Public Health. She is a Fellow and board member (2019-2022) of the International Society of Pharmacoepidemiology (ISPE), a member of the Medical Device Epidemiology (MDEpiNet) Scientific Oversight Committee, and Associate Editor for Pharmacoepidemiology and Drug Safety. Her career spans more than 15 years in government, industry, consulting, and academia focused on better understanding medical product safety and effectiveness when used in actual clinical practice. She is adept with scientific, technical, and logistical aspects of feasibility, utilization, safety, and effectiveness real-world studies for postmarketing requirements, labeling expansion, clinical trial support studies, and pragmatic clinical trials. She enjoys engaging with clinical and research teams to gather knowledge, generate evidence, inform decision-makers, and communicate meaningful results to regulators, payers, clinicians, and patients.
