{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T16:37:18Z","timestamp":1793551038773,"version":"4.5.0"},"reference-count":23,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Participant diversity is important for reducing study bias and increasing generalizability of comparative effectiveness research.<\/jats:p><\/jats:sec>Objective<\/jats:title>Demonstrate the operational efficiency of a centralized electronic health record (EHR)-based model for recruiting difficult-to-reach participants in a pragmatic trial.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This comparative effectiveness study was a secondary analysis of Diuretic Comparison Project, a randomized clinical trial conducted between 2016 and 2022 (mean [SD] follow-up, 2.4 [1.4] years) comparing 2 commonly prescribed antihypertensives, which used an EHR-based recruitment model. Electronic study workflows, in tandem with routine clinical practice, were adapted by 72 Veteran Affairs (VA) primary care networks. Data were analyzed from August to December 2022.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Measures reflecting recruitment capacity (monthly rate), operational efficiency (median time for completion of electronic procedures), and geographic reach (percentage of patients recruited from rural areas) were examined.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 13\u202f523 patients with hypertension (mean [SD] age, 72 [5.4] years; 13\u202f092 male [96.8%]) were recruited from 537 outpatient clinics. Approximately 205 patients were randomized per month and a median of 35 days (Q1-Q3, 23-80 days) was needed to complete electronic recruitment. The annual income was below the national median for 69% of the cohort. Patients from all 50 states, Puerto Rico, and the District of Columbia were included and 45% resided in rural areas.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this secondary analysis of a multicenter pragmatic trial, a centralized EHR-based recruitment model was associated with improved participation from underrepresented groups. These participants often are difficult to reach, with their exclusion potentially biasing trial results; eliminating in-person study visits and local site involvement can minimize barriers for the recruitment of patients from rural and lower socioeconomic areas.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>The Diuretic Comparison Project (DCP) was registered on ClinicalTrials.gov Identifier: NCT02185417<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.32049","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T15:32:16Z","timestamp":1693582336000},"page":"e2332049","source":"Crossref","is-referenced-by-count":10,"title":["A Centralized EHR-Based Model for the Recruitment of Rural and Lower Socioeconomic Participants in Pragmatic Trials"],"prefix":"10.1001","volume":"6","author":[{"given":"Cynthia","family":"Hau","sequence":"first","affiliation":[{"name":"VA Cooperative Studies Program Coordinating Center, Boston, 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