译文（字数 6847）：

实施大型保险系统随机有效性测试

作者：Niteesh K. Choudhry,  William H. Shrank 

背景

需要确定如何最好地安排健康保险和提供医疗服务是比较效益研究中心优先事项。研究旨在评估这些问题在大型保险制度经常进行。我们试图描述进行在这种情况下试验时所面临的挑战。

方法

使用心肌梗死后免费接收事件和经济评价（MI FREEE）试验作为一个例子，我们描述进行大型保险制度试验的方法和实际挑战。

结果

我们遇到的六大关键挑战，同时进行MI FREEE试验，即需要获得计划发起人同意进行试验，计划发起人的渴望拥有他们所有的受益人收到同样的干预，基于声明的识别方法不准确而产生的影响索赔落后于潜在的符合条件的患者按时入学，病人不愿参加保险为基础的干预和知情同意的潜在需求，在现实世界输送系统的频繁推出新cointerventions，而高利率的损失来后续因保险“客户流失。”我们描述了用于克服这些挑战的方法。

外文原文（字符数 21960）：

Implementing randomized effectiveness trials in large insurance systems

Niteesh K. Choudhry, , William H. Shrank 

Abstract

Background

The need to identify how best to structure health insurance and to deliver health care services is a central priority for comparative effectiveness research. Studies designed to evaluate these issues are frequently conducted in large insurance systems. We sought to describe the challenges faced when conducting trials in this context.

Methods

Using the Post-Myocardial Infarction Free Rx Event and Economic Evaluation (MI FREEE) trial as an example, we describe the methodological and practical challenges of conducting trials in large insurance systems.

Results

We encountered six key challenges while conducting MI FREEE trial, namely the need to obtain plan sponsor permission to experiment, the desire of plan sponsors to have all of their beneficiaries receive the same intervention, the inaccuracy of claims-based identification methods and the impact of claims lag on the timely enrollment of potentially eligible patients, the reluctance of patients to participate in insurance-based interventions and the potential need for informed consent, the frequent introduction of new cointerventions in real-world delivery systems, and the high rates of loss to follow-up because of insurance “churn.” We describe the approaches we used to overcome these challenges.