|
In this chapter, we
have discussed multi-faceted interventions to improve outcomes
of patients with chronic symptoms. We have described specific
changes to health care systems that have been shown to improve
patient outcomes. Although many of the examples we cited are specific
to arthritis, these principles can and have been applied to other
chronic conditions (e.g. diabetes, congestive heart failure) to
reduce symptoms and improve overall health status and function.
Approaches to evaluating
multi-faceted innovations in health care systems differ from the
traditional paradigm of the randomized clinical trial in which
a single intervention is tested against a control condition that
controls for all factors except the hypothesized "active ingredient".
There are many examples of successful evaluation of multi-faceted
health care innovations in the published literature, including
both experimental and observational designs. Rigorous evaluation
of such multi-faceted innovations in health care, and the synthesis
of results across studies, have the potential to make substantial
contributions to the knowledge base for improving care of patients
with chronic symptomatic conditions. Progress requires a broad
understanding that the traditional approaches of the randomized
clinical trial and meta-analysis of single interventions are not
the only valid and useful scientific approaches to generating
new knowledge.
Considerable progress
has been made in identifying multi-faceted system changes that
improve patient outcomes. However, it is important to recognize
that the traditional methods of the randomized controlled trial
need to be adapted to address the unique scientific problems in
evaluating multi-faceted changes to health care systems that are
needed to improve outcomes.
|