Abstract:
AIMS AND OBJECTIVES:To describe the application of systems and complexity science principles to real patient care. RATIONALE:Our current global health care system is not sustainable. It is structured based on the principles of reductionist science, which was discovered and developed over the past 400 to 600 years. Because of increasing pace of change and increasing complexity in our world, we have increased fragmentation in our health care system leading to more harm and waste. Over 100 years ago, the principles of systems, or complexity, science were discovered, first in the discipline of physics. These principles accommodate the constant change and biologic variability in our world. While reductionist principles would be applicable in a static, mechanical world where parts of the system could be isolated, this does not exist in the real biologic world. METHODS:For the past decade, our abdominal wall hernia team has been applying the principles of systems science to real patient care. Some of the tools we have applied include continuous quality improvement for whole hernia patient processes and non-linear analytical tools to gain insight to improve value-based outcomes. Until we learn to apply and scale these principles across our whole global health care system, we will continue to suffer the consequences of our current unsustainable system. RESULTS:We have learned that the application of systems and complexity science to real patient care can lead to lower costs and better outcomes in the context of patients with complex hernia problems. However, these concepts have not yet been adopted in our global health care system. CONCLUSION:Applying the principles of systems and complexity science to our global health care system has the potential to lower costs and improve patient outcomes for any patient care process to which it is applied.
journal_name
J Eval Clin Practjournal_title
Journal of evaluation in clinical practiceauthors
Ramshaw Bdoi
10.1111/jep.13442subject
Has Abstractpub_date
2020-10-01 00:00:00pages
1559-1563issue
5eissn
1356-1294issn
1365-2753journal_volume
26pub_type
杂志文章abstract:RATIONALE:Self-assessed health (SAH) status is a very simple four-, or five-category self-reported measure of health status that has been shown to be a powerful predictor of mortality, service use and total cost of medical care treatment. It is therefore reasonable to suggest that pre-intervention SAH may influence the...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2005.00563.x
更新日期:2005-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The onset of acute illness may be accompanied by a profound sense of disorientation for patients. Addressing this vulnerability is a key part of a physician's purview, yet well-intended efforts to do so may be impeded by myriad competing tasks in clinical practice. Resolving this dilemma ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13410
更新日期:2020-05-07 00:00:00
abstract::Sturmberg et al write about multimorbidity as "several diagnosable diseases within the same individual." They posit that this syndrome is the result of multiple interconnected disturbances reflecting scale-free, fractal signs of pathology ranging from biochemical/hormonal alterations at one end of a spectrum to commun...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12706
更新日期:2018-12-01 00:00:00
abstract::Strand and Parkkinen criticize our dispositional account of causation in evidence-based medicine for failing to provide a proper epistemology of causal knowledge. In particular, they claim that we do not explain how causal inferences should be drawn. In response, we point out that dispositionalism does indeed have an ...
journal_title:Journal of evaluation in clinical practice
pub_type: 评论,杂志文章
doi:10.1111/jep.12189
更新日期:2014-12-01 00:00:00
abstract::The paper evaluates the importance of conceptions underlying practices in medicine and in medical education. It uses a study of anaesthetists' approaches to practice, and of lectures in problem-based learning, to illustrate the influence of a conception of 'applying knowledge in, or to, practice' and of its apparently...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2000.00264.x
更新日期:2000-08-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Cambodia is one of the 22 countries with a high burden of tuberculosis (TB). People often first seek treatment for cough and other TB symptoms through private pharmacies. The National Tuberculosis Programme trained willing private sector pharmacies to refer TB symptomatic clients to their...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12306
更新日期:2015-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Mortality prediction models using logistic regression analysis play a pivotal role in intensive care quality evaluation, allowing a hospital's performance to be compared with a standard. However, when a difference between predicted and observed mortality exists, that is, the numerator of ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01240.x
更新日期:2010-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The incidence of falls and fall-related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall-...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01307.x
更新日期:2010-12-01 00:00:00
abstract:RATIONALE, AIMS & OBJECTIVES:A variety of transition of care interventions has been evaluated to date to reduce readmissions. No studies evaluated effectiveness of clinical pharmacist's home-visits to recently discharged Medicare Advantage patients with the goal of preventing subsequent readmissions and urgent care use...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12495
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:Models for the structured delivery of care rely on organizational attributes of practice teams. The Survey of Organizational Attributes for Primary Care (SOAPC) is known to be a valid instrument to measure this aspect in the primary care setting. The aim of this study was to determine the validity of a transl...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2009.01330.x
更新日期:2010-12-01 00:00:00
abstract:RATIONALE:There is growing interest in validating tools aimed at supporting the clinical decision-making process and research. However, an increased bureaucratization of clinical practice and redundancies in the measures collected have been reported by clinicians. Redundancies in clinical assessments affect negatively ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,随机对照试验
doi:10.1111/jep.12539
更新日期:2016-10-01 00:00:00
abstract:RATIONALE AIMS AND OBJECTIVES:Pulmonary aspiration is a feared complication of anaesthesia that is associated with significant morbidity and mortality. Within the small existing body of literature on medical malpractice claims related to periprocedural aspiration, very little information is available regarding the case...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13086
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to examine the impact of the use of an inter-professional care team on patient length of stay and payer charges in a geriatric transitional care unit. METHODS:An analysis of de-identified administrative records for transitional care patients for the 12-month period (2003-2004) care...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.01114.x
更新日期:2010-02-01 00:00:00
abstract:INTRODUCTION:How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM,...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13307
更新日期:2020-04-01 00:00:00
abstract:RATIONALE, AIMS, AND OBJECTIVES:Heterogeneity is a critical issue in meta-analysis, because it implies the appropriateness of combining the collected studies and impacts the reliability of the synthesized results. The Q test is a traditional method to assess heterogeneity; however, because it does not have an intuitive...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13159
更新日期:2020-02-01 00:00:00
abstract::The foundationalist and anti-foundationalist conceptions of medical knowledge have been at loggerheads for decades. Evidence-based medicine (EBM), the most prominent form of foundationalism, has attained wide appeal and acceptance among authorities. It proposes that evidence is the "base" upon which all clinical decis...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.13273
更新日期:2020-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Little is known about the quality of occupational health care provided to National Health Service (NHS) staff. We designed the first national clinical audits of occupational health care in England. We chose to audit depression and back pain as health care workers have high levels of both ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2010.01574.x
更新日期:2012-04-01 00:00:00
abstract::In clinical medicine, a balance needs to be struck between reductionism (the view that a system can be fully understood in terms of its isolated parts) and holistic complexity appreciation (the view that the whole may not be discernible from knowledge of its parts). Reductionism, which currently is associated with ren...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.1999.00188.x
更新日期:1999-05-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:The prevailing view on implementation interventions to improve the organization and management of health care is that the interventions should be tailored to potential barriers. Ideally, possible barriers are analysed before the quality improvement interventions are developed to influence...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,评审
doi:10.1111/j.1365-2753.2006.00660.x
更新日期:2007-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Single-group interrupted time series analysis (ITSA) is a popular evaluation methodology in which a single unit of observation is studied; the outcome variable is serially ordered as a time series, and the intervention is expected to "interrupt" the level and/or trend of the time series, ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12638
更新日期:2017-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Appropriate indications for colonoscopy (C) are essential for a rational use of resources. The aim of this study is to evaluate the appropriateness of indication for C according to the American Society for Gastrointestinal Endoscopy (ASGE) guidelines and to evaluate whether appropriate us...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2008.00950.x
更新日期:2009-02-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Individual comparisons of the performance of risk-adjustment indices have been widely conducted. Few reviews have been conducted to summarize the performance of different risk-adjustment indices. A 30-day mortality rate is widely used to evaluate the quality of care in hospitals by federa...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章,meta分析,评审
doi:10.1111/jep.12307
更新日期:2015-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of SA. This study describ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12103
更新日期:2014-04-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:In 2011 the module cardiometabolic risk of the Prevention Consultation guideline was introduced in the Netherlands in order to prevent cardiometabolic diseases. We aimed to compare attitudes and working methods of Dutch general practitioners (GPs) towards selective prevention of cardiomet...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12179
更新日期:2014-08-01 00:00:00
abstract:RATIONALE AND AIMS:Among the problems to the publicly funded national health services are the waiting lists. Patients who need elective surgery generally have long waiting times before treatment. We aimed to develop a new prioritization tool for primary hip and knee replacement. METHODS:Criteria were developed using a...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2006.00733.x
更新日期:2007-06-01 00:00:00
abstract::A small percentage of emergency department (ED) visitors account for a disproportionate portion of ED visits. Little is known about their relationships with their primary care providers (PCPs). This study compares frequent and infrequent ED visitors' primary care utilization and perceptions of primary care access, con...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12672
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Development of chronic disease risk prediction models has become a growing area of research in recent years. The internal validity of such models is sometimes lower than estimated from the development sample. Overfitting or overoptimism of the developed model and/or differences between the samples are likely...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2012.01834.x
更新日期:2013-04-01 00:00:00
abstract::Access to appointments in primary care is not routinely measured, and there is no one standardized method for doing so. Any measurement tool has to take account of the dynamic status of appointment availability and the definitional problems of appointment types. The aim of this study was to develop and trial a method ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1046/j.1365-2753.2003.00386.x
更新日期:2003-02-01 00:00:00
abstract::Cartwright and Munro argued that extrapolation of findings from randomized controlled trials to other settings can be difficult because information about the underlying causal structure and subgroups is often not available. They advocated the use of 'capacities' - that is fixed causal contributions - in predicting eff...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/j.1365-2753.2012.01909.x
更新日期:2012-10-01 00:00:00
abstract:RATIONALE, AIMS AND OBJECTIVES:We aim to determine the prevalence of reconciliation errors (REs) at admission to surgery departments, report their potential clinical impact and analyse possible risk factors. METHODS:Prospective observational study was conducted for 8 months in a regional public hospital in Spain. The ...
journal_title:Journal of evaluation in clinical practice
pub_type: 杂志文章
doi:10.1111/jep.12403
更新日期:2016-02-01 00:00:00