{"doi":"10.1093/geront/gnaa220","title":"Findings of Sequential Pilot Trials of Aliviado Dementia Care to Inform an Embedded Pragmatic Clinical Trial","abstract":"BACKGROUND AND OBJECTIVES: Many investigators of Alzheimer's disease and related dementias (AD/ADRD) are unfamiliar with the embedded pragmatic clinical trials (ePCTs) and the indispensable pilot phase preceding ePCTs. This paper provides a much-needed example for such a pilot phase and discusses implementation barriers and additional infrastructure and implementation strategies developed in preparation for a nationwide AD/ADRD ePCT. RESEARCH DESIGN AND METHODS: Two pilot trials were conducted in 2 hospices sequentially to refine and test Aliviado Dementia Care-Hospice Edition, a complex quality improvement intervention for advanced dementia symptom management. Readiness for the subsequent full-scale ePCT was assessed by three milestones: ≥80% training completion rate (\"feasibility\"), ≥80% posttraining survey respondents indicating intention for practice changes (\"applicability\"), and at least 1 Aliviado care plan/assessment instrument administered in ≥75% of dementia patients admitted to home hospice within 1-month posttraining (\"fidelity\"). RESULTS: Participants included 72 interdisciplinary team members and 11 patients with AD/ADRD across the pilots. Feasibility, applicability, and fidelity outcomes (92%, 93%, and 100%, respectively) all surpassed the preestablished milestones (80%, 80%, and 75%). Main implementation challenges were related to hospice staff turnover, integration of the Aliviado toolbox materials within the electronic health records, and hospices' limited research experience and infrastructure. DISCUSSION AND IMPLICATIONS: This pilot phase demonstrated feasibility, applicability, and fidelity required to proceed to the full-scale ePCT. Our study findings and discussions of additional infrastructure and implementation strategies developed following the pilot phase can inform researchers and clinicians interested in conducting AD/ADRD-related pilot studies for ePTCs or quality improvement initiatives. CLINICAL TRIALS REGISTRATION NUMBER: NCT03681119.","journal":"The Gerontologist","year":2020,"id":72334,"datarank":0.8226232501701192,"base_score":2.833213344056216,"endowment":2.833213344056216,"self_citation_contribution":0.42498200160843247,"citation_network_contribution":0.39764124856168676,"self_endowment_contribution":0.42498200160843247,"citer_contribution":0.39764124856168676,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":10,"citers_with_citation_signal":7,"citers_with_endowment":7,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9621,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03681119","NCT04175977"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":381421,"name":"Catherine Schneider","orcid":"0000-0001-5813-0690","position":1,"is_corresponding":false},{"id":381422,"name":"Alycia A. Bristol","orcid":"0000-0001-5027-9984","position":2,"is_corresponding":false},{"id":382299,"name":"Maureen Clancy","orcid":null,"position":3,"is_corresponding":false},{"id":382300,"name":"Sara A Sprague","orcid":null,"position":4,"is_corresponding":false},{"id":381423,"name":"Melissa D. Aldridge","orcid":"0000-0002-3334-4542","position":5,"is_corresponding":false},{"id":382301,"name":"Tara Cortes","orcid":null,"position":6,"is_corresponding":false},{"id":381424,"name":"Keith Goldfeld","orcid":"0000-0002-0292-8780","position":7,"is_corresponding":false},{"id":381425,"name":"Jean S. Kutner","orcid":"0000-0002-8079-831X","position":8,"is_corresponding":false},{"id":312977,"name":"Susan L. Mitchell","orcid":null,"position":9,"is_corresponding":false},{"id":382069,"name":"Joseph W. Shega","orcid":null,"position":10,"is_corresponding":false},{"id":381426,"name":"Bei Wu","orcid":"0000-0001-9388-0630","position":11,"is_corresponding":false},{"id":67989,"name":"Carolyn W. Zhu","orcid":"0000-0002-2318-715X","position":12,"is_corresponding":false},{"id":381427,"name":"Abraham A. Brody","orcid":"0000-0002-3405-7043","position":13,"is_corresponding":false},{"id":381420,"name":"Shih‐Yin Lin","orcid":"0000-0001-8033-2889","position":0,"is_corresponding":true}],"reference_count":36,"raw_metadata":null,"created_at":"2026-07-18T21:44:45.622639Z","pmid":"33377138","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}