Article

Journal of General Internal Medicine

, Volume 21, Issue 2, pp S30-S34

Using complexity theory to build interventions that improve health care delivery in primary care

  • David LitakerAffiliated withVA HSR&D Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Department of Medicine, Case Western Reserve UniversityDepartments of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University
  • , Anne TomoloAffiliated withVA HSR&D Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Department of Medicine, Case Western Reserve University
  • , Vincenzo LiberatoreAffiliated withDivision of Computer Sciences, School of Engineering, Case Western Reserve University
  • , Kurt C. StangeAffiliated withDepartments of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve UniversityDepartments of Family Medicine and Sociology, School of Medicine, Case Comprehensive Cancer Center, Case Wester Reserve University
  • , David AronAffiliated withVA HSR&D Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Department of Medicine, Case Western Reserve UniversityDepartments of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University Email author 

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Abstract

Previous observational research confirms abundant variation in primary care practice. While variation is sometimes viewed as problematic, its presence may also be highly informative in uncovering ways to enhance health care delivery when it represents unique adaptations to the values and needs of people within the practice and interactions with the local community and health care system. We describe a theoretical perspective for use in developing interventions to improve care that acknowledges the uniqueness of primary care practices and encourages flexibility in the form of intervention implementation, while maintaining fidelity to its essential functions.

Key words

health care delivery nonlinear dynamics quality of health care