title: Organizational interventions employing principles of complexity science have improved outcomes for patients with Type II diabetes.
abstract: BACKGROUND
  Despite the development of several models of care delivery for patients with chronic illness, consistent improvements in outcomes have not been achieved. These inconsistent results may be less related to the content of the models themselves, but to their underlying conceptualization of clinical settings as linear, predictable systems. The science of complex adaptive systems (CAS), suggests that clinical settings are non-linear, and increasingly has been used as a framework for describing and understanding clinical systems. The purpose of this study is to broaden the conceptualization by examining the relationship between interventions that leverage CAS characteristics in intervention design and implementation, and effectiveness of reported outcomes for patients with Type II diabetes.
  
  
  METHODS
  We conducted a systematic review of the literature on organizational interventions to improve care of Type II diabetes. For each study we recorded measured process and clinical outcomes of diabetic patients. Two independent reviewers gave each study a score that reflected whether organizational interventions reflected one or more characteristics of a complex adaptive system. The effectiveness of the intervention was assessed by standardizing the scoring of the results of each study as 0 (no effect), 0.5 (mixed effect), or 1.0 (effective).
  
  
  RESULTS
  Out of 157 potentially eligible studies, 32 met our eligibility criteria. Most studies were felt to utilize at least one CAS characteristic in their intervention designs, and ninety-one percent were scored as either "mixed effect" or "effective." The number of CAS characteristics present in each intervention was associated with effectiveness (p = 0.002). Two individual CAS characteristics were associated with effectiveness: interconnections between participants and co-evolution.
  
  
  CONCLUSIONS
  The significant association between CAS characteristics and effectiveness of reported outcomes for patients with Type II diabetes suggests that complexity science may provide an effective framework for designing and implementing interventions that lead to improved patient outcomes.
authors.affiliation: South Texas Veterans Health Care System, University of Texas Health Science Center at San Antonio, San Antonio TX, 78229, USA. leykum@uthscsa.edu
authors.forename: Luci K
authors.initials: LK
authors.lastname: Leykum
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Pugh
authors.forename: Valerie
authors.initials: V
authors.lastname: Lawrence
authors.forename: Michael
authors.initials: M
authors.lastname: Parchman
authors.forename: Polly H
authors.initials: PH
authors.lastname: Noël
authors.forename: John
authors.initials: J
authors.lastname: Cornell
authors.forename: Reuben R
authors.initials: RR
authors.lastname: McDaniel