title: CHARTing a Path to Pragmatic Tobacco Treatment Research.
abstract: It is important to consider the degree to which studies are explanatory versus pragmatic to understand the implications of their findings for patients, healthcare professionals, and policymakers. Pragmatic trials test the effectiveness of interventions in real-world conditions; explanatory trials test for efficacy under ideal conditions. The Consortium of Hospitals Advancing Research on Tobacco (CHART) is a network of seven NIH-funded trials designed to identify effective programs that can be widely implemented in routine clinical practice.
  
  
  
  A cross-sectional analysis of CHART trial study designs was conducted to place each study on the pragmatic-explanatory continuum. After reliability training, six raters independently scored each CHART study according to ten PRagmatic Explanatory Continuum Indicator Summary (PRECIS) dimensions, which covered participant eligibility criteria, intervention flexibility, practitioner expertise, follow-up procedures, participant compliance, practitioner adherence, and outcome analyses. Means and SDs were calculated for each dimension of each study, with lower scores representing more pragmatic elements. Results were plotted on "spoke and wheel" diagrams. The rating process and analyses were performed in October 2014 to September 2015.
  
  
  
  All seven CHART trials tended toward the pragmatic end of the spectrum, although there was a range from 0.76 (SD=0.23) to 1.85 (SD=0.58). Most studies included some explanatory design elements.
  
  
  
  CHART findings should be relatively applicable to clinical practice. Funders and reviewers could integrate PRECIS criteria into their guidelines to better facilitate pragmatic research. CHART study protocols, coupled with scores reported here, may help readers improve the design of their own pragmatic trials.
authors.affiliation: Department of Psychology, Federal University of Juiz de Fora, Minas Gerais, Brazil. Electronic address: ecruvinel@yahoo.com.br.
authors.forename: Erica
authors.initials: E
authors.lastname: Cruvinel
authors.affiliation: Department of Preventive Medicine and Public Health and The University of Kansas Cancer Center, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Kimber P
authors.initials: KP
authors.lastname: Richter
authors.affiliation: National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Stoney
authors.affiliation: College of Nursing, Ohio State University, Columbus, Ohio; Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Sonia
authors.initials: S
authors.lastname: Duffy
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fellows
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Harrington
authors.affiliation: Department of Medicine and Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: Departments of Population Health, Medicine and Psychiatry; New York University School of Medicine, New York, New York.
authors.forename: Scott
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Hilary A
authors.initials: HA
authors.lastname: Tindle
authors.affiliation: Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island.
authors.forename: Theresa I
authors.initials: TI
authors.lastname: Shireman
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Donna
authors.initials: D
authors.lastname: Shelley
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, Oregon.
authors.forename: Lisa
authors.initials: L
authors.lastname: Waiwaiole
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, California.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cummins
mesh_terms: D003430:Cross-Sectional Studies; D006761:Hospitals; D006801:Humans; D064792:Pragmatic Clinical Trials as Topic; D012107:Research Design; D020340:Tobacco Use Cessation