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Racing to Enroll, Failing to Retain: The Pitfalls of Competitive Enrollment in Clinical Trials

In multisite clinical research, speed is often regarded as the primary measure of success. Yet the “fastest to fill” approach to competitive enrollment, rewarding sites for volume and velocity, can undermine the very outcomes clinical trials are designed to achieve: reliable data, sustainable budgets, and participant retention.

The Pitfall: High Costs of Rapid Enrollment

In traditional competitive enrollment studies, sites rush to enroll patients who may not be ideal candidates for long-term participation. This creates:

High screen-failure rates that erode efficiency and inflate costs.
Increased dropout rates that disrupt timelines and data availability.
Strained site operations balancing heavy administrative loads and resource constraints.
Rushed patient experiences that weaken engagement and increase attrition risk.

Combined, these factors extend budgets and timelines, consume additional resources, and jeopardize the very outcomes trials seek to achieve.

The Impact: Retention as a Critical Determinant of Trial Success

Retention is not simply a metric; it is foundational to the integrity and credibility of clinical research. High screen-failure rates and participant attrition diminish confidence in outcomes, erode operational efficiency, and strain relationships between sponsors, sites, and participants. Addressing these issues requires a model that prioritizes both accuracy and long-term engagement.

The Solution: ProSciento’s Precision Enrollment

ProSciento’s Precision Enrollment flips the script. Instead of incentivizing volume and speed as the only benchmarks, it rewards accuracy, engagement, and retention to help sponsors and sites achieve more predictable, sustainable outcomes.

Key elements of our model include:

Retention-Focused Incentives and Engagement
Retention is built into the model from the start. Beyond per-visit payments, sites receive incentives tied to participant retention through study completion. We provide consistent communication, patient education, and engagement tools that help maintain participant motivation and reduce attrition risk, turning short-term recruitment into long-term participation and engagement.
High-Touch Site Support and Strategic Selection
Every site is paired with a dedicated coordinator responsible for onboarding, training, recruitment, and ongoing engagement activities. This high-touch support relieves administrative burden, improves communication, and allows sites to focus on patient care while still achieving enrollment goals.
Sites are also strategically selected based on proven access to eligible patients identified through centralized prescreening, ensuring the model’s effectiveness from the outset.
Real-Time Insights and Dynamic Oversight
Through our Site Performance Portal, sponsors and sites gain real-time visibility into key metrics such as enrollment progress, screen failures, and retention trends. Interactive dashboards highlight site-specific challenges early, enabling rapid corrective action and maintaining steady, predictable enrollment pacing. This real-time transparency and communication between all stakeholders enables proactive decision-making and quality improvement throughout the trial lifecycle.
Expertise and Experience
We would be remiss if we didn’t mention the value of our people and their deep expertise in metabolic clinical research. Our Clinical Research Associate (CRA) team brings decades of combined experience managing early phase and complex metabolic studies. They are more than monitors; they act as trusted partners who anticipate challenges, provide high-touch guidance, and ensure that every site receives consistent, responsive support.

The Precision Enrollment Advantage

Our approach doesn’t just change the process, it changes the results. Studies that adopt Precision Enrollment have seen:

25% fewer screen failures
90% of enrollment targets achieved on time
92% retention through study completion

These outcomes translate into more predictable trial costs, reduced waste of screening materials and investigational products, and stronger sponsor-site relationships.

Case Example: Precision Enrollment in Action

To illustrate how this model works in practice, consider the following real-world example. This case highlights how moving away from open, volume-driven enrollment to a precision-based model can improve both operational efficiency and participant retention.

A sponsor conducting a multisite metabolic disease trial experienced significant operational challenges under an open-enrollment model, including nearly 40% screen failures and elevated dropout rates. These issues contributed to costly delays and compromised timelines.

ProSciento implemented its Precision Enrollment model:

Centralized prescreening ensured that only qualified patients were referred to sites.
Strategic site selection paired high-potential sites with dedicated coordinators.
Real-time dashboards provided continuous visibility into enrollment and retention metrics.

Results: screen failures decreased by 25%, retention improved by 15%, and enrollment was completed on schedule without compromising quality or participant engagement.

Why It Matters

Precision Enrollment represents more than a procedural shift; it reflects a strategic realignment of priorities in clinical research. By elevating retention and engagement to the forefront, sponsors can safeguard timelines, enhance data integrity, and improve the overall experience for sites and participants.

Author:

Casey Ustick, Vice President of Commercial Operations, ProSciento, Inc.

Published October 27, 2025

Not Just Another CRO.

The Metabolic CRO.

For over 22 years, ProSciento has been dedicated to advancing clinical research for diseases across the metabolic continuum. Our science-driven, patient-focused approach has helped bring forward new methodologies, drug classes, and devices that have advanced metabolic disease management and care for millions worldwide.

With focused expertise in early phase (phase 1–2b) clinical trials, we excel in complex protocol design, optimized study execution, and effective enrollment strategies. Our full-scope services, from development planning and trial conduct to data analysis and publication, help clients reach early decision milestones and generate high-quality data to support continued development and, when relevant, licensing opportunities.

Discover how our specialized team delivers unmatched value and efficiency in metabolic clinical trials: https://prosciento.com/connect-with-our-experts/, or connect with one of experts directly at bd@prosciento.com.