title: Using complexity theory to build interventions that improve health care delivery in primary care.
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.
authors.affiliation: VA HSR&D Center for Quality Improvement Research, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Department of Medicine, Case Western Reserve University, OH 44106, USA.
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.forename: Anne
authors.initials: A
authors.lastname: Tomolo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Liberatore
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.forename: David
authors.initials: D
authors.lastname: Aron
mesh_terms: D003153:Community Health Services / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D006284:Health Plan Implementation; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D017711:Nonlinear Dynamics; D010348:Patient Care Team; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012945:Social Values; D013598:Systems Theory; D017749:Total Quality Management / Q000379:methods*; D014481:United States; D014493:United States Department of Veterans Affairs