Suchergebnisse

Einleitung -- Teil 1 - Komplexität und Gesundheitswesen -- Komplexitätswissenschaften.-Visualisierung komplexer adaptiver Systeme -- Definition von Gesundheit -- Teil 2 - Das "ideale" Gesundheitssystem -- Das ideale Gesundheitssystem -- Das ideale Gesundheitssystem - eine organisatorische Perspektive -- Das ideale Gesundheitssystem - Beispiele aus der Praxis -- Führung - eine Voraussetzung für die Verwirklichung eines idealen Gesundheitssystems -- Teil 3 - Ein personenzentriertes, gerechtes und nachhaltiges Gesundheitssystem erreichen -- Analyse der Funktionsweise von Gesundheitssystemen als Systeme -- Neugestaltung von Gesundheitssystemen - Anwendung von CAS-Ansätzen -- Adipositas - ein vielschichtiger Ansatz -- Komplexe adaptive Gesundheitssysteme - eine Win-Win-Win-Lösung -- Anhänge - Literaturauszüge -- Konzeptuelle Rahmen der Komplexitätswissenschaften -- Ein pragmatischer Leitfaden für Führungskräfte zur Veränderung von Rahmen und Denkgewohnheiten für Komplexitätsdenker -- Leitfaden zur Entwicklung eines Modells Werte im Gesundheitswesen.

Intro -- Preface -- Acknowledgments -- Contents -- Contributors -- Part I Introduction: A Systems and Complexity Science Understanding of Health -- If You Change the Way You Look at Things, Things You Look at Change. Max Planck's Challenge for Health, Health Care, and the Healthcare System -- 1 Looking Differently: At Health, Dis-ease and Disease -- 1.1 Most People Are Healthy Most of the Time -- 1.2 Dis-ease Versus Disease Versus Health -- 1.3 The Cause of Disease -- 1.3.1 The Fallacy of `Macroscopic Causation' -- 1.3.2 The Emergence of a Network Physiological Understanding of Health and Disease -- 1.4 Disease: An Outcome of Mal-/Adaptive Regulatory Feedback -- 1.4.1 Genome Regulation -- 1.4.2 Autonomous Nervous System and HPA-Axis Regulation -- 1.4.3 Mitochondrial Regulation -- 1.5 Diseases as Phenotypes -- 1.6 Health, Dis-ease and Disease: A `Whole of Person' Phenomenon -- 1.7 Detecting Physiological Dysregulation -- 1.7.1 Biomarkers of Physiological Dysregulation Have Limited Application in Clinical Practice -- 1.8 … Your Appreciation of Health, Dis-ease and Disease Changes -- 2 Looking Differently: At Healthcare Delivery -- 2.1 Health Care: Is That Really What We Do? -- 2.1.1 Shifting of the-Mental-Mind Frame -- 2.1.2 In Essence Health Professionals Are Disease Managers -- 2.1.3 Disinterest in the Person with the Disease -- 2.2 Disease Care at Work -- 2.2.1 Communication: About Disease -- 2.2.2 A Protocol-/Guideline-Driven Approach to Disease Management -- 2.2.3 Disease Management Results in Wasting Scarce Resources -- 2.3 Health Workforce Composition -- 2.3.1 Evaluating Outcomes: Which Ones Count? -- 2.4 … Your Appreciation of the Healthcare Delivery Changes -- 3 Looking Differently: At the Healthcare System -- 3.1 The Disease Focus Diverts Attention and Resources Away from `Being Healthy' and `Staying Healthy'.

Intro -- Foreword -- Notes from the New World -- Preface -- Health System ReDesign -- Diversity of Views -- Moving Forward -- Acknowledgements -- Contents -- 1 We Need a Systemic Approach for the Redesign of Health Systems -- 1.1 Mindsets/Worldviews -- 1.1.1 A Complexity Mindset -- 1.1.2 Systems and Complexity Thinking in Health and Healthcare -- 1.2 Health System Redesign: More than Health System Reform -- 1.3 Designing a Complex Adaptive Health System -- References -- Addendum 1 -- Policy Making Cycles in Four Countries ch1:bib34,ch1:bib35,ch1:bib36,ch1:bib37 -- Addendum 2 -- Obamacare Health System Chart -- Addendum 3 -- Canterbury Health District (NZ) Health System Redesign Chart -- Part I Complexity and Health: Challenging the Orthodoxy -- Complexity and Health -- References -- 2 Complexity Sciences -- 2.1 Complex Systems Are … -- 2.2 The Essence of Systems Thinking -- 2.3 Complex Systems Theory: An Overview -- 2.4 A Detailed Description of ``Complex Adaptive Systems'' -- 2.5 Consequences of Complex Adaptive System Behaviour -- References -- Addendum 1 -- The History of Complexity Sciences -- Addendum 2 -- The Philosophy of CAS - Paul Cilliers ch2:bib57 -- Addendum 3 -- Why Do We Need the Science of Complexity to Tackle the Most Difficult Questions? - David Krakauer -- 3 Visualisation of Complex Adaptive Systems -- 3.1 The Vortex Metaphor -- 3.2 System Structure and System Dynamics -- 3.3 Understanding Different Degrees of Complexity: The Cynefin Framework -- References -- 4 Defining Health -- 4.1 Defining Health -- 4.1.1 Distinguishing Health from Disease -- 4.2 The Complex Adaptive Nature of Health -- 4.2.1 Disturbing the Balance of Health: The Patterns of Illness and Disease -- 4.2.2 The Changing Relationships of Structure and Function in Health and Disease -- 4.2.3 The Physiology of Health and Disease -- 4.3 Measuring Health

This idea-packed resource takes systems and complexity sciences out of blue-sky territory and into the concrete world of contemporary healthcare practice. Beginning with a new reframing of health and illness, its chapters redesign traditional disease-centered models of care into modern, health-centered-and patient-centered-health service systems. The approaches shown here combine innovation and common sense to recognize and attend to patients' needs across areas including health education and training, information accessibility, health service organization and delivery, and disease in individual context. The variety of solutions applied to this wide spectrum of issues shows the suitability of systems, complexity, and adaptive thinking to the ongoing objectives of making health services more responsive, effective, and equitable. Highlights of the coverage: Healthy smoker: an oxymoron? Maybe, but it is more complicated than that Transforming monitoring and improving care with variability-derived clinical decision support Linking Gulf War illness to genome instability, somatic evolution, and complex adaptive systems Complexity of knowledge in primary care: understanding the discipline's requisite knowledge: a bibliometric study New ways of knowing and researching: integrating complexity into a translational health sciences program Understanding the emergency department ecosystem using agent-based modelling Putting Systems and Complexity Sciences into Practice is an inspiring idea book that sill interest health policymakers, health financiers, organizational leaders, healthcare administrators, clinicians, researchers, students, and interested lay readers.

Intro -- Preface -- Acknowledgements -- Contents -- List of Contributors -- Part I Complexity in Clinical Care -- 1 ``Returning to Holism'': An Imperative for the Twenty-First Century -- 1.1 Models: Mental Representations of Reality -- 1.2 Distributions in Living Systems -- 1.3 Characteristics of CAS -- 1.4 Holism -- 1.5 Re-framing Health -- 1.5.1 Health as a Dynamic Entity -- 1.5.2 Health and Dis-ease as Experiential States -- 1.5.3 Operationalising Health as a Complex Adaptive State: The Somato-Psycho-Socio-Semiotic Model -- 1.5.4 Dynamics of Health -- 1.6 Health as the Organising Principle for a Twenty-First Century Health System -- 1.7 Implications for the Twenty-First Century -- References -- 2 Systems Biology: Unravelling Molecular Complexity in Health and Disease -- 2.1 Introduction -- 2.2 Holism: An Imperative for the Twenty-First Century -- 2.2.1 Disease Complexity: Malfunction of Molecular Networks -- 2.2.2 Ethical Complexities in Systems Medicine -- 2.2.3 Improving Healthcare Through Complexity Science -- 2.3 Experimental Design for Systems Biology -- 2.4 Conclusions -- References -- 3 Complicated vs. Complex, Disease vs. Illness: Rethinking Diagnosis, Therapy, and Restoring Health -- 3.1 Complex vs. Complicated Systems -- 3.2 The Primacy of Dynamic Patterns in Health and Illness -- 3.3 Disrupted Dynamic Patterns on the Pathway to Illness and Disease -- 3.4 Disease and Illness: Chicken or Egg? -- 3.5 The Complex Systems-Osteopathic Medicine Synergy: Treating Illness and Restoring Health -- References -- 4 A System for Systems Epidemiology: The Example of Inference from Agent-Based Models -- 4.1 Systems and Epidemiology: The Conceptual Argument -- 4.2 Systems and Epidemiology: An Empirical Example -- 4.2.1 Model -- 4.2.2 Simulations -- 4.2.3 Findings -- 4.2.4 Implications -- References.

Background: The Australian Ecology of Medical Care indicates that 255/1,000 Australians consult a GP 1.8 times/month (466 consultations/month) resulting in 42 specialist, 1.4 ED and 1.9 hospital referrals, 478 prescriptions, 220 pathology and 48 radiology tests, costing the Government $ 72,009 (2012–13). Government believes this to be unsustainable and controllable by setting price signals. Objectives: To investigate the impact of 'small changes' to health service utilisation and/or resource use. Method: Modelling the impact of increases and decreases to healthcare utilisation/resource use over a 5-year period. Results: Strategies targeting only one variable had a small and linear impact on healthcare expenditure (± 0.6–7.2%); combining changes had an exponential effect, achieving an up to 15% reduction or an over 20% rise in expenditure. Discussion: Change invariably results in trade-offs; modelling is a tool that can provide a basis to engage in shared discussions about the 'yes, but/yes, and' considerations of reform propositions