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Commentary Evaluating Complex Healthcare Systems: A Critique of Four Approaches

By Heather Boon, Hugh Macpherson, Sue Fleishman, Sameline Grimsgaard, Mary Koithan, Arne Johan Norheim and Harald Walach

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 b

Topics: complex interventions – research methods – whole systems research Background Complex treatment syste, public h
Year: 2008
OAI identifier: oai:CiteSeerX.psu:10.1.1.134.2729
Provided by: CiteSeerX
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