title: The balanced incomplete block design is not suitable for the evaluation of complex interventions.
abstract: OBJECTIVE
  In quality of care research, the balanced incomplete block (BIB) design is regularly claimed to have been used when evaluating complex interventions. In this article, we reflect on the appropriateness of using this design for evaluating complex interventions.
  
  
  METHODS
  Literature study using PubMed and handbooks.
  
  
  RESULTS
  After studying various articles on health services research that claim to have applied the BIB and the original methodological literature on this design, it became clear that the applied method is in fact not a BIB design.
  
  
  CONCLUSIONS
  We conclude that the use of this design is not suited for evaluating complex interventions. We stress that, to prevent improper use of terms, more attention should be paid to proper referencing of the original methodological literature.
authors.affiliation: Department of General Practice, School for Public health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: Jasper.Trietsch@maastrichtuniversity.nl.
authors.forename: Jasper
authors.initials: J
authors.lastname: Trietsch
authors.affiliation: Department of Epidemology, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: Leffers
authors.affiliation: Department of General Practice, School for Public health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Ben
authors.initials: B
authors.lastname: van Steenkiste
authors.affiliation: IQ Healthcare, Radbout University Nijmegen, PO Box 9101 (144), 6500HB Nijmegen, The Netherlands.
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
authors.affiliation: Department of General Practice, School for Public health and Primary Care (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
mesh_terms: D006302:Health Services Research / Q000379:methods*; D006801:Humans; D011643:Publishing / Q000592:standards*; D012107:Research Design
keywords: Epidemiologic research design; Evaluation studies; Health care evaluation mechanisms; Primary care; Quality of health care; Research methodology