Background
More than six million Americans are living with Alzheimer’s Disease and AD-Related Dementias (AD/ADRD). People living with dementia (PLWD) are particularly vulnerable to receiving uncoordinated and poor-quality care, ultimately leading to adverse health outcomes, poor quality of life, and misuse of resources. Strategies to improve care of PLWD must be informed by high-quality evidence. While prior research has identified opportunities for improvement, the adoption of promising interventions has been hindered by limited evidence of their effectiveness under “real-world” conditions.
The National Institute on Aging (NIA) IMbedded Pragmatic Alzheimer’s Disease (AD) and AD-Related Dementias (AD/ADRD) Clinical Trials (IMPACT) Collaboratory was established in 2019 to meet the urgent public health need to deliver high-quality, evidence-based care for PLWD and their care partners within the health care systems (HCS) that serve them.
Context
More than 6 million Americans are living with AD/ADRD. PLWD are particularly vulnerable to receiving uncoordinated and poor quality care, ultimately leading to adverse health outcomes, poor quality of life, and misuse of resources. Strategies to improve their care must be informed by high-quality evidence.
ePCTs Bridge Research and Clinical Care
The NIA IMPACT Collaboratory focuses on enabling the conduct of ePCTs among PLWD in a variety of health care settings that serve them. Pragmatic clinical trials embedded in health care systems (ePCTs) are designed to test the effectiveness of interventions under “real-world” conditions, and thus have the potential to accelerate the translation of evidence-based interventions into clinical practice.
IMPACT Collaboratory: The First Five Years
In its first five years, IMPACT Collaboratory established its infrastructure to enable its research funding, training, and knowledge generation objectives. Through 11 national competitions, it funded 30 research grants, including 24 Pilot ePCTs and six Demonstration Projects of full-scale ePCTs. It also established several training grant mechanisms to build investigator capacity to conduct rigorous ePCTs, with 10 National Competitions resulting in funding for including 12 Career Development Awards, 7 Health Care Systems Scholars, and 4 Real World Data Scholars.
The IMPACT Collaboratory established a collaborative community of over 150 investigators at all career stages to realize its mission. This community generated over 450 publications, reports, presentations, and other products to advance the methods to conduct ePCTs in dementia care. In addition, the IMPACT Collaboratory partnered with health care systems in settings that care for people with dementia to build the platforms needed to conduct ePCTs. Most notably, in partnership with NIA and the American Health Care Association, the IMPACT Collaboratory established the Long-Term Care Data Cooperative, in which over 2,500 nursing homes nationwide submit their electronic health records to a common data platform that any investigator can apply to use to conduct research.
IMPACT Collaboratory: The Next Five Years
In September 2025, the NIA renewed IMPACT for another five years. The accomplishments achieved in its first cycle provide a strong foundation to realize the full potential of this remarkable national infrastructure and ultimately to translate its resources into meaningful improvements in the quality of care delivered to Americans with dementia and their care partners.