Epoc Taxonomy Guidance

Suggested citation: Effective Practice and Organisation of Care (EPOC).
The EPOC taxonomy of health systems

interventions. EPOC Resources for review authors. Oslo: Norwegian Knowledge Centre for the Health Services;
2016. epoc.cochrane.org/epoc-taxonomy (accessed DD Month YYYY)
The EPOC taxonomy of health systems interventions
Background
The scope of the Cochrane EPOC Group covers a broad range of health systems
interventions. To help review authors and users of our review findings to better describe
and organise these interventions, we have developed a taxonomy that can be used to
classify health systems interventions into categories based on conceptual or practical
similarities.
How the taxonomy was developed

The first EPOC taxonomy of health systems interventions was developed in 2002, and
included the following categories: (1) professional interventions; (2) financial interventions;
(3) organisational interventions; and (4) regulatory interventions.
This taxonomy was extensively revised and updated between 2013 and 2015 to address key
gaps and also to bring the EPOC taxonomy into alignment with other taxonomies that were
being used to classify health systems interventions in widely used online databases (Lavis
2015). Our starting point was a taxonomy for health systems arrangements developed for
the Health Systems Evidence database (www.healthsystemsevidence.org) (Lavis 2015). We
applied this taxonomy to all of the interventions included in four overviews of systematic
reviews of health systems interventions of high relevance to low income countries (Ciapponi
2014; Herrera 2014; Pantoja 2014; Wiysonge 2014). The taxonomy was then revised
iteratively to ensure that all of the included reviews were appropriately categorized and that
all relevant health system arrangements and implementation strategies were included and
organized logically. We then applied the revised taxonomy to all of the interventions
covered by EPOC reviews. Further minor revisions were made to the taxonomy at this stage
to ensure appropriate categorisation of interventions and we also refined the definitions of
each of the categories and subcategories.
Overview of the EPOC taxonomy

The EPOC taxonomy includes four main domains of interventions (Table 1).
Table 1: Main domains of the EPOC taxonomy of health systems interventions

Category Definition
Delivery arrangements Changes in how, when and where healthcare is organized
and delivered, and who delivers healthcare
Financial arrangements Changes in how funds are collected, insurance schemes, how
services are purchased, and the use of targeted financial
incentives or disincentives
Governance arrangements Rules or processes that affect the way in which powers are
exercised, particularly with regard to authority,
accountability, openness, participation, and coherence
Implementation strategies Interventions designed to bring about changes in healthcare
1
organizations, the behaviour of healthcare professionals or
the use of health services by healthcare recipients
Each of these main domains includes a number of categories and subcategories, and these
can be viewed here.
We recognise that there is overlap between categories and subcategories, and that some
interventions could be classified in more than one category. For example ‘telemedicine’ is
classified as an ICT intervention and could also be classified as a change in where care is
provided and a change to the healthcare environment. If review authors are concerned
about overlap we advise that they address this when writing the protocol, or in the update
of a review, by focusing on the function of the intervention within the context of their
review. We welcome suggestions on how the EPOC taxonomy can be improved – please
send suggestions to [email protected]
We also recognise that there is no universally agreed upon classification system for health
systems interventions and that any system for categorising health system interventions is,
to some extent, arbitrary. However, we hope that this taxonomy will facilitate explicit and
systematic synthesis and interpretation of the existing body of evidence on health systems
interventions across studies.
How review authors can use the EPOC taxonomy

Review authors can use the taxonomy in a number of ways:
 To understand and explore the scope of EPOC
 To see where reviews have been undertaken and where gaps exist. Some of these gaps
are reflected in a list of priority review topics
 To explore where a proposed intervention would fit into the taxonomy. This may help in
conceptualising interventions, and developing inclusion criteria, when planning a new
review or an update
 To group interventions in reviews that include multiple types of interventions for a
particular group of people (e.g. people with multimorbidity in primary care or
community settings) or to improve a particular outcome (e.g. the proportion of health
professionals serving in rural and other underserved areas). In such reviews, the
taxonomy may also be helpful as a framework for exploring heterogeneity
We recognise that individual subcategories within the EPOC taxonomy can be further
broken down into groups of related interventions and that the taxonomy does not provide
this level of detail. Review authors can draw on existing taxonomies for a specific
subcategory of intervention to further differentiate and organise interventions for a
particular review. Examples of where this has been done include the review of interventions
to reduce corruption in the health sector (Gaitonde 2010) and the review of interventions
for improving coverage of child immunization in low- and middle-income countries (Oyo-Ita
2011).
2
References:
Ciapponi A, Lewin S, Bastías G, Dudley L, Flottorp S, Gagnon MP, Garcia Marti S, Glenton C, Herrera
CA, Okwundu CI, Opiyo N, Oxman AD, Pantoja T, Paulsen E, Peñaloza B, Rada G, Suleman F,
Wiysonge CS. Delivery arrangements for health systems in low-income countries: an overview of
systematic reviews (Protocol). Cochrane Database of Systematic Reviews. 2014, Issue 5. Art. No.:
CD011083.
Gaitonde R, Bjørndal A, Oxman AD, Okebukola PO, Ongolo-Zogo P. Interventions to reduce

corruption in the health sector (Protocol). Cochrane Database of Systematic Reviews 2010, Issue 11.
Art. No.: CD008856.
Herrera CA, Ciapponi A, Bastías G, Lewin S, Garcia Marti S, Okwundu CI, Opiyo N, Oxman AD, Pantoja
T, Paulsen E, Peñaloza B, Rada G, Wiysonge CS. Governance arrangements for health systems in low-
income countries: an overview of systematic reviews (Protocol). Cochrane Database of Systematic
Reviews. 2014, Issue 4. Art. No.: CD011085.
Lavis JN, Wilson MG, Moat KA, Hammill AC, Boyko JA, Grimshaw JM, Flottorp S. Developing and
refining the methods for a 'one-stop shop' for research evidence about health systems. Health
Research Policy and Systems 2015;13(10):1-10.
Oyo-Ita A, Nwachukwu CE, Oringanje C, Meremikwu MM. Interventions for improving coverage of
child immunization in low- and middle-income countries. Cochrane Database of Systematic Reviews
2011, Issue 7. Art. No.: CD008145.
Pantoja T, Opiyo N, Ciapponi A, Dudley L, Gagnon MP, Herrera CA, Lewin S, Garcia Marti S, Oxman
AD, Paulsen E, Peñaloza B, Rada G, Volmink J, Wiysonge CS. Implementation strategies for health
systems in low-income countries: an overview of systematic reviews (Protocol). Cochrane Database
of Systematic Reviews. 2014, Issue 5. Art. No.: CD011086.
Wiysonge CS, Herrera CA, Ciapponi A, Lewin S, Garcia Marti S, Opiyo N, Oxman AD, Pantoja T,
Paulsen E, Peñaloza B, Rada G. Financial arrangements for health systems in low-income countries:
an overview of systematic reviews (Protocol). Cochrane Database of Systematic Reviews. 2014, Issue
4. Art. No.: CD011084.

Epoc Taxonomy Guidance

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Suggested citation: Effective Practice and Organisation of Care (EPOC).

The EPOC taxonomy of health systems

The EPOC taxonomy of health systems interventions

How the taxonomy was developed

Overview of the EPOC taxonomy

Table 1: Main domains of the EPOC taxonomy of health systems interventions

How review authors can use the EPOC taxonomy

Gaitonde R, Bjørndal A, Oxman AD, Okebukola PO, Ongolo-Zogo P. Interventions to reduce

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