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There are several challenges
to designing and evaluating interventions directed at changing
health care systems.
- While "stand-alone"
interventions have been shown to improve patient outcomes, a
challenge is to develop and test integrated systems of patient
care that combine diverse elements.
- A second challenge
is to devise health care systems capable of delivering effective
care on a sustained basis to all patients in a defined population
who may benefit from it.
- A third challenge
is to develop systems of care that individuals and society can
afford, and to evaluate the costs and cost-effectiveness of
providing such care relative to care as usual. These approaches
to conducting research and organizing scientific evidence fall
under the rubric of evidence-based
medicine.
The following sections
provide an overview of the kinds of changes to health care systems
that have been shown to enhance outcomes in chronic disease. We
then consider how multi-faceted interventions that include each
of these components can be evaluated when implemented in health
care delivery systems.
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