ArticleEvidence-based complementary and alternative medicine : eCAM2007
Evaluating complex healthcare systems: a critique of four approaches.
Article in Evidence-based complementary and alternative medicine : eCAM, 2007. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Management of patients with cancer pain: an evaluation of AGREE II-based clinical practice guidelines.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025Pooled it
- Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial.BMC family practice · 2015Trial
- Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study.BMC complementary and alternative medicine · 2011Trial
- Framework for evidence synthesis of traditional, complementary and integrative medicine systems incorporating context and complexity, illustrated by the example of homeopathy.Frontiers in public health · 2026Article
- Parallels Between Cupping in Traditional Chinese Medicine andMedical acupuncture · 2024Article
- SEAttle-based Research of Chinese Herbs for COVID-19 Study: A Whole Health Perspective on Chinese Herbal Medicine for Symptoms that may be Related to COVID-19.Global advances in health and medicine · 2022Article
- Whole Systems Research Methods in Health Care: A Scoping Review.Journal of alternative and complementary medicine (New York, N.Y.) · 2019Article
- Contributing to Global Health: Development of a Consensus-Based Whole Systems Research Strategy for Anthroposophic Medicine.Evidence-based complementary and alternative medicine : eCAM · 2019Article
- Integrative health care - What are the relevant health outcomes from a practice perspective? A survey.BMC complementary and alternative medicine · 2017Article
- How Should We Respond to Non-Dominant Healing Practices, the Example of Homeopathy.Journal of bioethical inquiry · 2017Article
- An interpretive review of consensus statements on clinical guideline development and their application in the field of traditional and complementary medicine.BMC complementary and alternative medicine · 2017Review
- Whole Medical Systems versus the System of Conventional Biomedicine: A Critical, Narrative Review of Similarities, Differences, and Factors That Promote the Integration Process.Evidence-based complementary and alternative medicine : eCAM · 2017Review
- A General Pediatrics and Integrative Medicine Approach to Pervasive Refusal Syndrome: A Case Report.The Permanente journal · 2016Article
- Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study.Global advances in health and medicine · 2014Review
- Long-term outcomes of anthroposophic treatment for chronic disease: a four-year follow-up analysis of 1510 patients from a prospective observational study in routine outpatient settings.BMC research notes · 2013Observational
- State-space grid analysis: applications for clinical whole systems complementary and alternative medicine research.Forschende Komplementarmedizin (2006) · 2012Review
- A grounded theory study of homeopathic practitioners' perceptions and experiences of the homeopathic consultation.Evidence-based complementary and alternative medicine : eCAM · 2011Article
- Using Chinese version of MYMOP in Chinese medicine evaluation: validity, responsiveness and minimally important change.Health and quality of life outcomes · 2010Article
- Anthroposophic therapy for attention deficit hyperactivity: a two-year prospective study in outpatients.International journal of general medicine · 2010Article
- Geffen Faculty Highlight Concerns Linking CAIM and Conventional Researchers at UCLA Symposium.Evidence-based complementary and alternative medicine : eCAM · 2010Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or 'whole' systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK), whole systems research, whole medical systems research described by NCCAM (USA) and a model from NAFKAM (Norway). Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced); the necessity of using mixed methods including randomized clinical trials (RCTs) (explanatory and pragmatic) and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM) as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first) especially with respect to how the 'definitive' RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.