Evaluating complex healthcare systems: A critique of four approaches

ecam.gif    From the latest issue of Evidence-based Complementary & Alternative Medicine (eCAM), an Open Access journal:

Boon H, MacPherson H, Fleishman S, Grimsgaard S, Koithan M, Norheim AJ et al. Evaluating complex healthcare systems: A critique of four approaches. eCAM 2007; 4(3):279-285.

Abstract: The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or whole’ systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK), whole systems research, whole medical systems research described by NCCAM (USA) and a model from NAFKAM (Norway). Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced); the necessity of using mixed methods including randomized clinical trials (RCTs) (explanatory and pragmatic) and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM) as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first) especially with respect to how the definitive’ RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems. Full Text


Reinventing CME: The role of the care pilot in the medical group practice

jacm.gif   Here is an interesting article from the October/December 2007 issue of the Journal of Ambulatory Care Management:

Greene BR, Filerman GL. Reinventing CME: The role of the care pilot in the medical group practice. J Ambul Care Manage 2007; 30(4):283-290.

Abstract: This article recommends that the content of traditional continuing medical education be changed significantly to include the concepts and skills necessary to enable practice teams to feedback information into the practice, which would result in the creation of a learning organization with the ability to plan for and anticipate future activities. The primary role in this new organization would be called a care pilot who would have as a primary responsibility, the successful navigation and improvement of the 6 aims as spelled out in the Institute of Medicine report Crossing the Quality ChasmPubMed Record    Journal Record