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 February 6, 2026: Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: The PACBACK Randomized Clinical Trial (Gert Bronfort, DC, PhD; Brent Leininger, DC, MS, PhD)
February 6 @ 1:00 pm - 2:00 pmGrand Rounds February 13, 2026: The Making of the PCORnet? The COMPARE-Pediatric IBD Study (Michael D. Kappelman, MD, MPH)
February 13 @ 1:00 pm - 2:00 pmGrand Rounds February 20, 2026: Applying Mind-Body Skills for Pain Using a Whole Health Telehealth Intervention (RAMP): Early Progress and Lessons Learned (Diana Burgess, PhD; Roni Evans, DC, MS, PhD; Katie Hadlandsmyth, PhD)
February 20 @ 1:00 pm - 2:00 pmGrand Rounds February 27, 2026: Optimal Transfusion Strategy in High Cardiac Risk Patients After Major Surgery: Results of the TOP Trial (Panos Kougias, MD, MSc; Sherene Sharath, PhD, MPH)
February 27 @ 1:00 pm - 2:00 pm
NEWS
- February 4, 2026: Spinal Manipulation and Biopsychosocial Self-Management for Back Pain, in This Week’s Rethinking Clinical Trials Grand RoundsIn this Friday’s Rethinking Clinical Trials Grand Rounds, Gert Bronfort and Brent Leininger of the University of Minnesota will present “Spinal Manipulation and Clinician-Supported Biopsychosocial Self-Management for Acute Back Pain: ...
- January 29, 2026: Early Bird Registration for HCSRN Annual Conference Ends March 2Early bird registration for the 2026 Annual Conference of the Health Care Systems Research Network (HCSRN) will on March 2. Postdoctoral students are eligible for discounted registration. This year’s conference will ...
- January 28, 2025: Assessing Whether Ambient Artificial Intelligence Can Improve Health Practitioner Well-Being, in This Week’s Rethinking Clinical Trials Grand RoundsIn this Friday’s Rethinking Clinical Trials Grand Rounds, Majid Afshar and Mary Ryan Baumann of the University of Wisconsin-Madison will present “A Pragmatic Randomized Controlled Trial of Ambient Artificial Intelligence ...