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Abstract
Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members’ interactions continuously change over time in response to the stress generated by its surrounding environment. This paper will review the challenges of intervening and introducing a planned change into a complex adaptive health care delivery system. We explore the role of the “reflective adaptive process” in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system. We finally describe the implementation of a new program, the Aging Brain Care Medical Home as a case study of our proposed evaluation process.
Acknowledgements
Dr Boustani is supported by the National Institute on Aging (NIA) Paul B. Beeson K23 Career Development Award # 1-K23-AG026770-01 and R01AG029884-01. Dr Callahan is supported by NIA awards K24-AG026770 and P30AG024967. There are no conflicts of interest for these authors.