A recent editorial co-authored by NIA IMPACT Collaboratory Design and Statistics Core member Thomas G. Travison, PhD, published in JAMA, examines the delicate balance between real-world flexibility and scientific rigor in pragmatic clinical trials.

The article explores how researchers can generate meaningful, actionable evidence in everyday healthcare settings without sacrificing the methodological standards necessary to guide clinical decision-making.

The authors argue that rather than writing off real-world challenges—such as missing electronic health record data or low treatment adherence—as unavoidable limitations, trialists should treat these patterns as vital data. Analyzing why and how adherence varies in real-world environments provides essential insight into who actually benefits from an intervention and how it functions outside ideal lab conditions.

The authors emphasize that pragmatic trials must deliver reliable, high-quality evidence that patients, clinicians, and health systems can trust when making real-world care decisions.

Access the full editorial here.