AHRQ Views: Blog posts from AHRQ leaders
Addressing Complexity: The AHRQ Series on Complex Interventions
Everyone—patients, clinicians, researchers, and health systems—needs to use evidence to make informed health care decisions. When health care interventions are complex, often having multiple components addressing many aspects of a given clinical or care delivery problem, there are unique challenges in understanding and using the evidence about their effectiveness.
For example, programs to improve management of diabetes typically include multiple components. Many different approaches have been developed and studied to support people with diabetes in changing their diets, controlling blood sugar, increasing exercise, and managing their condition with medications. An AHRQ research review shows the interventions vary widely in how long they engaged patients, how much they engaged patients, how they engaged patients, the selection of activities for individual patients, and whether or how they engage communities. Additionally, people with diabetes have different needs and health care settings differ in their capacity to implement these programs.
The effectiveness of complex interventions is influenced by multiple factors: individual characteristics and social determinants of health, elements of the health care delivery system, and the interventions themselves. They may be dependent on behavior change in patients or their providers; or, they may need to be tailored to be effective in different populations.
Researchers need to address special challenges in order to synthesize the evidence on complex interventions. While methods for conducting systematic reviews on discrete treatments such as drugs or procedures are well-defined and widely used, these methods are often inadequate for systematic reviews of complex interventions and different approaches are needed
The AHRQ Series on Complex Intervention Systematic Reviews was recently published in the Journal of Clinical Epidemiology to provide guidance. It outlines analysis methods to help systematic reviewers answer questions about health care delivery such as:
- What are the most effective models of care for people with multiple chronic conditions?
- How can falls be prevented among older adults?
- How can hospital admissions and readmissions be prevented?
- Can practice facilitation improve the quality of primary care?
- How can diabetes and its complications be prevented?
- How can health disparities be eliminated?
Groundwork for the journal series began in 2015, when AHRQ's Evidence-based Practice Center (EPC) Program expanded previous efforts to provide guidance on research methods by hosting a meeting of 57 experts in the field. Those discussions and subsequent work led to this seven-paper series, a valuable new resource for conducting systematic reviews of complex interventions. This series focuses on:
- How to define complex interventions
- How to define the scope of a research review of complex interventions
- How to communicate complexity through the use of frameworks
- How to choose among available analytic methods based on the research question
- How to achieve improved and consistent reporting through new reporting standards
Researchers can use these articles to support their work, and thus their research can better inform decisions clinicians and patients make every day about how best to maintain and improve health. Users of evidence on complex interventions can also use these articles to help them assess the rigor of the systematic reviews they turn to, to inform their decisions.
For over two decades, AHRQ's EPC Program has been at the forefront of developing methods and standards for conducting systematic reviews. We critically appraise and synthesize literature, providing the needed evidence to inform decision making for practice and policy, while at the same time identifying important research gaps.
AHRQ is committed to providing the evidence to support improvements in health care quality and safety. We strive to understand what works—for whom, and under which circumstances—by providing information and tools for health care researchers, professionals, and systems to help them improve care for their patients. The new articles on complex interventions align with AHRQ's efforts to bridge the gap between research and practice and accelerate the uptake of evidence, enabling everyone involved to make the best possible decisions about health care.
Dr. Bierman is the Director of AHRQ's Center for Evidence and Practice Improvement.