The document discusses selecting and evaluating interventions in complex adaptive health care systems (CAS). It outlines principles for selecting changes in a CAS, including building a shared vision and fostering diversity. It also discusses using a Reflective Adaptive Process (RAP) team to introduce localized, flexible changes. Outcomes should be monitored continuously using N-of-1 randomized controlled trials to evaluate impacts on overall system outcomes over time. Key challenges include selecting appropriate interventions and outcomes to measure in the complex, emergent environment of a CAS.

1. Selecting An Intervention In A Complex Adaptive Health Care System & Evaluating Its Impact Malaz Boustani, MD, MPH Indianapolis Discovery Network for Dementia Indiana University center for Aging Research Regenstrief Institute, Inc www.indydiscoverynetwork.com

3. Independent Agent E Other Local CASs Stress Feedback Independent Agent D Independent Agent C Independent Agent B Independent Agent A Changing Environment Connection The health care CAS Emergent Performance

10. Selecting an Intervention

16. Evaluating the Impact of the Selected Interventions

17. Methodological Quality “ Extent to which a study’s design, conduct, and analysis has minimized selection, measurement , and confounding biases” West et al, 2002

22. N-OF-1 RCT in CAS 0----------1------------2-----------3-----------4----------5-----------6------------7-----------8-------------9-----------10------------11------------12 Time Outcome Data Outcome Data Outcome Data Outcome Data Outcome Data Outcome Data Outcome Data R to Int R to Int R to Int R to UC R to UC R to UC