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[[Complexity science]] and chaos theory are proposed as further explaining the nature of medical knowledge<ref name="isbn1-85775-724-6">{{cite book |author=Sweeney, Kieran  |title=Complexity in Primary Care: Understanding Its Value |publisher=Radcliffe Medical Press |location=Abingdon |year=2006 |pages= |isbn=1-85775-724-6 |oclc= |doi=}}[http://www.acpjc.org/Content/147/3/issue/ACPJC-2007-147-3-A11.htm Book review]</ref><ref name="isbn1-85775-855-2">{{cite book |author=Holt, Tim A | title=Complexity for Clinicians |publisher=Radcliffe Medical Press |location=Abingdon |year=2004 |pages= |isbn=1-85775-855-2 |oclc= |doi=}} [http://www.mja.com.au/public/bookroom/2007/zwar/zwar.html Book review], [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463117 ACP Journal Club Review]</ref> and education<ref name="pmid11588088">{{cite journal |author=Fraser SW, Greenhalgh T |title=Coping with complexity: educating for capability |journal=BMJ |volume=323 |issue=7316 |pages=799–803 |year=2001 |pmid=11588088 |doi=}}</ref>.
[[Complexity science]] and chaos theory are proposed as further explaining the nature of medical knowledge<ref name="isbn1-85775-724-6">{{cite book |author=Sweeney, Kieran  |title=Complexity in Primary Care: Understanding Its Value |publisher=Radcliffe Medical Press |location=Abingdon |year=2006 |pages= |isbn=1-85775-724-6 |oclc= |doi=}}[http://www.acpjc.org/Content/147/3/issue/ACPJC-2007-147-3-A11.htm Book review]</ref><ref name="isbn1-85775-855-2">{{cite book |author=Holt, Tim A | title=Complexity for Clinicians |publisher=Radcliffe Medical Press |location=Abingdon |year=2004 |pages= |isbn=1-85775-855-2 |oclc= |doi=}} [http://www.mja.com.au/public/bookroom/2007/zwar/zwar.html Book review], [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1463117 ACP Journal Club Review]</ref> and education<ref name="pmid11588088">{{cite journal |author=Fraser SW, Greenhalgh T |title=Coping with complexity: educating for capability |journal=BMJ |volume=323 |issue=7316 |pages=799–803 |year=2001 |pmid=11588088 |doi=}}</ref>.


In health services research, although complexity theory has not advanced to the state of being able to mathematically model healthcare delivery, it has been used as a framework for case study<ref name="pmid-15802542">{{cite journal |author=Anderson RA ''et al.''|title=Case study research: the view from complexity science |journal=Qualitative Health Res |volume=15 |pages=669–85 |year=2005 |pmid=15802542 |doi=10.1177/1049732305275208}}</ref><ref name="pmid-11674890">{{cite journal |author=Miller WL ''et al.''|title=Practice jazz: understanding variation in family practices using complexity science |journal=J Fam Pract |volume=50 |pages=872–8 |year=2001 |pmid=11674890 |doi=|url=http://www.jfponline.com/Pages.asp?AID=2354&issue=October%202001}}</ref><ref name="pmid-11674891">{{cite journal |author=Crabtree BF ''et al.'' |title=Understanding practice from the ground up |journal=J Fam Pract |volume=50 |pages=881–7 |year=2001 |pmid=11674891 |doi=|url=http://www.jfponline.com/Pages.asp?AID=2355&issue=October%202001}}</ref><ref name="pmid-17339983">{{cite journal |author=Sturmberg JP |title=Systems and complexity thinking in general practice: part 1 - clinical application |journal=Australian Family Physician |volume=36 |pages=170–3 |year=2007 |pmid=17339983 |doi=}}</ref><ref name="pmid18026806">{{cite journal |author=Safford MM, Allison JJ, Kiefe CI |title=Patient complexity: more than comorbidity. the vector model of complexity |journal=J Gen Intern Med |volume=22 Suppl 3 |issue= |pages=382–90 |year=2007 |pmid=18026806 |doi=10.1007/s11606-007-0307-0}}</ref> and traditional bivariate analysis<ref name="pmid-17725834">{{cite journal |author=Leykum LK ''et al.'' |title=Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes |journal=Implementation Science : IS |volume=2  |pages=28 |year=2007 |pmid=17725834 |doi=10.1186/1748-5908-2-28}}</ref> of healthcare delivery. For example, a [[systematic review]] of organizational interventions to improve the quality of care of [[diabetes mellitus type 2]] suggests that interventions based on complexity theory will be more successful.<ref name="pmid-17725834"/>
In health services research, although complexity theory has not advanced to the state of being able to mathematically model healthcare delivery, it has been used as a framework for case study<ref name="pmid-15802542">{{cite journal |author=Anderson RA ''et al.''|title=Case study research: the view from complexity science |journal=Qualitative Health Res |volume=15 |pages=669–85 |year=2005 |pmid=15802542 |doi=10.1177/1049732305275208}}</ref><ref name="pmid-11674890">{{cite journal |author=Miller WL ''et al.''|title=Practice jazz: understanding variation in family practices using complexity science |journal=J Fam Pract |volume=50 |pages=872–8 |year=2001 |pmid=11674890 |doi=|url=http://www.jfponline.com/Pages.asp?AID=2354&issue=October%202001}}</ref><ref name="pmid-11674891">{{cite journal |author=Crabtree BF ''et al.'' |title=Understanding practice from the ground up |journal=J Fam Pract |volume=50 |pages=881–7 |year=2001 |pmid=11674891 |doi=|url=http://www.jfponline.com/Pages.asp?AID=2355&issue=October%202001}}</ref><ref name="pmid-17339983">{{cite journal |author=Sturmberg JP |title=Systems and complexity thinking in general practice: part 1 - clinical application |journal=Australian Family Physician |volume=36 |pages=170–3 |year=2007 |pmid=17339983 |doi=}}</ref><ref name="pmid18026806">{{cite journal |author=Safford MM, Allison JJ, Kiefe CI |title=Patient complexity: more than comorbidity. the vector model of complexity |journal=J Gen Intern Med |volume=22 Suppl 3 |issue= |pages=382–90 |year=2007 |pmid=18026806 |doi=10.1007/s11606-007-0307-0}}</ref> and traditional bivariate analysis<ref name="pmid-17725834">{{cite journal |author=Leykum LK ''et al.'' |title=Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes |journal=Implementation Science : IS |volume=2  |pages=28 |year=2007 |pmid=17725834 |doi=10.1186/1748-5908-2-28}}</ref><ref name="pmid20735859">{{cite journal| author=Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR| title=The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure. | journal=Implement Sci | year= 2010 | volume= 5 | issue=  | pages= 66 | pmid=20735859 | doi=10.1186/1748-5908-5-66 | pmc=PMC2936445 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20735859  }} </ref> of healthcare delivery. For example, a [[systematic review]] of organizational interventions to improve the quality of care of [[diabetes mellitus type 2]]<ref name="pmid-17725834"/>  and [[heart failure]]<ref name="pmid20735859"/> suggests that interventions based on complexity theory will be more successful.


Complexity science has been proposed as a model for organization change in medicine.<ref name="pmid16637958">{{cite journal |author=Litaker D, Tomolo A, Liberatore V, Stange KC, Aron D |title=Using complexity theory to build interventions that improve health care delivery in primary care |journal=J Gen Intern Med |volume=21 Suppl 2 |issue= |pages=S30–4 |year=2006 |month=February |pmid=16637958 |pmc=2557133 |doi=10.1111/j.1525-1497.2006.00360.x |url= |issn=}}</ref><ref name="pmid16637958">{{cite journal |author=Litaker D, Tomolo A, Liberatore V, Stange KC, Aron D |title=Using complexity theory to build interventions that improve health care delivery in primary care |journal=J Gen Intern Med |volume=21 Suppl 2 |issue= |pages=S30–4 |year=2006 |month=February |pmid=16637958 |pmc=2557133 |doi=10.1111/j.1525-1497.2006.00360.x |url= |issn=}}</ref> However, if the goal of modeling healthcare is to comply with specific quality indicators, interventions based on systems theory may be more effective than those based on complexity theory.<ref name="pmid-15175493">{{cite journal |author=Rhydderch M ''et al.'' |title=Organisational change theory and the use of indicators in general practice |journal=Quality & Safety in Health Care |volume=13 |pages=213–7 |year=2004 |pmid=15175493 |doi=10.1136/qhc.13.3.213}}</ref>
Complexity science has been proposed as a model for organization change in medicine.<ref name="pmid16637958">{{cite journal |author=Litaker D, Tomolo A, Liberatore V, Stange KC, Aron D |title=Using complexity theory to build interventions that improve health care delivery in primary care |journal=J Gen Intern Med |volume=21 Suppl 2 |issue= |pages=S30–4 |year=2006 |month=February |pmid=16637958 |pmc=2557133 |doi=10.1111/j.1525-1497.2006.00360.x |url= |issn=}}</ref><ref name="pmid16637958">{{cite journal |author=Litaker D, Tomolo A, Liberatore V, Stange KC, Aron D |title=Using complexity theory to build interventions that improve health care delivery in primary care |journal=J Gen Intern Med |volume=21 Suppl 2 |issue= |pages=S30–4 |year=2006 |month=February |pmid=16637958 |pmc=2557133 |doi=10.1111/j.1525-1497.2006.00360.x |url= |issn=}}</ref> However, if the goal of modeling healthcare is to comply with specific quality indicators, interventions based on systems theory may be more effective than those based on complexity theory.<ref name="pmid-15175493">{{cite journal |author=Rhydderch M ''et al.'' |title=Organisational change theory and the use of indicators in general practice |journal=Quality & Safety in Health Care |volume=13 |pages=213–7 |year=2004 |pmid=15175493 |doi=10.1136/qhc.13.3.213}}</ref>

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Lorenz butterfly showing effect of two attractors over time in a complex, chaotic system. Such systems are deterministic - i.e. they are not random, but indeed are completely determined by a fixed set of differential equations. However these systems are extremely sensitive in an "unpredictable" way to very slight perturbations, in that apparently trivial changes can sometimes (but unpredictably) produce a large effect. In a sense, such perturbations "cause" the ensuing effect, but not in any reproducible manner. Some risk factors for disease may be like such perturbations of a complex chaotic system in that they sometimes have a large effect but generally have no effect. Understanding how particular factors might influence disease processes in an unpredictable way may be important for managing some disease conditions.

Complexity science in health care

Complexity science and chaos theory are proposed as further explaining the nature of medical knowledge[1][2] and education[3].

In health services research, although complexity theory has not advanced to the state of being able to mathematically model healthcare delivery, it has been used as a framework for case study[4][5][6][7][8] and traditional bivariate analysis[9][10] of healthcare delivery. For example, a systematic review of organizational interventions to improve the quality of care of diabetes mellitus type 2[9] and heart failure[10] suggests that interventions based on complexity theory will be more successful.

Complexity science has been proposed as a model for organization change in medicine.[11][11] However, if the goal of modeling healthcare is to comply with specific quality indicators, interventions based on systems theory may be more effective than those based on complexity theory.[12]

In basic science research, fractal patterns have been found in cardiac conduction and fluctuations in vital signs over time.[13] Fractals are evidence of a system that follows the non-linear mathematics of a complex adaptive system. That are many other examples of fractal patterns in nature including the prediction of weather patterns.[14]

References

  1. ↑ Sweeney, Kieran (2006). Complexity in Primary Care: Understanding Its Value. Abingdon: Radcliffe Medical Press. ISBN 1-85775-724-6. Book review
  2. ↑ Holt, Tim A (2004). Complexity for Clinicians. Abingdon: Radcliffe Medical Press. ISBN 1-85775-855-2.  Book review, ACP Journal Club Review
  3. ↑ Fraser SW, Greenhalgh T (2001). "Coping with complexity: educating for capability". BMJ 323 (7316): 799–803. PMID 11588088. [e]
  4. ↑ Anderson RA et al. (2005). "Case study research: the view from complexity science". Qualitative Health Res 15: 669–85. DOI:10.1177/1049732305275208. PMID 15802542. Research Blogging.
  5. ↑ Miller WL et al. (2001). "Practice jazz: understanding variation in family practices using complexity science". J Fam Pract 50: 872–8. PMID 11674890. [e]
  6. ↑ Crabtree BF et al. (2001). "Understanding practice from the ground up". J Fam Pract 50: 881–7. PMID 11674891. [e]
  7. ↑ Sturmberg JP (2007). "Systems and complexity thinking in general practice: part 1 - clinical application". Australian Family Physician 36: 170–3. PMID 17339983. [e]
  8. ↑ Safford MM, Allison JJ, Kiefe CI (2007). "Patient complexity: more than comorbidity. the vector model of complexity". J Gen Intern Med 22 Suppl 3: 382–90. DOI:10.1007/s11606-007-0307-0. PMID 18026806. Research Blogging.
  9. ↑ 9.0 9.1 Leykum LK et al. (2007). "Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes". Implementation Science : IS 2: 28. DOI:10.1186/1748-5908-2-28. PMID 17725834. Research Blogging.
  10. ↑ 10.0 10.1 Leykum LK, Parchman M, Pugh J, Lawrence V, Noël PH, McDaniel RR (2010). "The importance of organizational characteristics for improving outcomes in patients with chronic disease: a systematic review of congestive heart failure.". Implement Sci 5: 66. DOI:10.1186/1748-5908-5-66. PMID 20735859. PMC PMC2936445. Research Blogging.
  11. ↑ 11.0 11.1 Litaker D, Tomolo A, Liberatore V, Stange KC, Aron D (February 2006). "Using complexity theory to build interventions that improve health care delivery in primary care". J Gen Intern Med 21 Suppl 2: S30–4. DOI:10.1111/j.1525-1497.2006.00360.x. PMID 16637958. PMC 2557133. Research Blogging.
  12. ↑ Rhydderch M et al. (2004). "Organisational change theory and the use of indicators in general practice". Quality & Safety in Health Care 13: 213–7. DOI:10.1136/qhc.13.3.213. PMID 15175493. Research Blogging.
  13. ↑ Goldberger AL (1996). "Non-linear dynamics for clinicians: chaos theory, fractals, and complexity at the bedside". Lancet 347: 1312–4. PMID 8622511. [e] Full text at Ebsco
  14. ↑ Lorenz's Model of Convection. Retrieved on 2007-11-21.
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