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Practical Challenges in the Conduct of Pragmatic Trials Embedded in Health Plans: Lessons of IMPACT-AFib, an FDA-Catalyst Trial

    Basic Details

    IMPACT-AFib was an 80,000-patient randomized clinical trial implemented by five US insurance companies (health plans) aimed at increasing the use of oral anticoagulants by individuals with atrial fibrillation who were at high risk of stroke and not on treatment. The underlying thesis was that patients could be change agents to initiate prescribing discussions with their providers. We tested the effect of mailing information to both patients and their providers. We used administrative medical claims and pharmacy dispensing data to identify eligible patients, to randomize them to an early or delayed intervention, and to assess clinical outcomes.


    Crystal J. Garcia, Kevin Haynes, Sean D. Pokorney, Nancy D. Lin, Cheryl McMahill-Walraven, Vinit Nair, Lauren Parlett, David Martin, Hussein R. Al-Khalidi, Debbe McCall, Christopher B. Granger, Richard Platt, Noelle M. Cocoros

    Corresponding Author

    Noelle M. Cocoros, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA