Conducting clinical trials in a constantly changing health care environment.

Continuous change and cost containment characterize the current health care system, making conduct of clinical trials and other clinical research difficult. Identification, accrual, and follow-up of patients who move between health care environments such as hospitals, nursing homes, schools and the home is particularly challenging. This article describes a circuit rider approach to patient identification and follow-up that was established by the Communication Sciences and Disorders Clinical Trials Research Group. It also gives suggestions for design of clinical trials in a constantly changing environment.