Introduction: Currently there are various definitions of patient care complexity with little consensus. The numbers of patients with complex care needs are increasing. To improve interventions for “complex patients” and appropriately reimburse healthcare providers it is important to determine the characteristics or contextual factors contributing to complexity. Method: Action research methods were used to enhance an explicit understanding of complexity. Several conferences were organized and primary care physicians, nurses, social science faculty, and patients shared their perspectives on patient care complexity. A subset of attendees created a complex patient screening tool, which was piloted by 12 primary care physicians with 267 patients to identify which factors contribute to complexity. Results: Complex patients were found to differ significantly from noncomplex patients based on factors associated with complexity. Based on latent class analysis, 58% of complex patients were characterized by multiple diagnoses, mental health issues, and a lack of effective participation in their care plans, while 42% of patients were considered complex because of multiple diagnoses only. In contrast, 90% of the noncomplex patients had no discernable pattern of health issues, while 10% of noncomplex patients had mental health and insurance issues that were easily managed. These results identify several factors that distinguish patients with complex care needs from those without complex care needs. The results also illustrate the heterogeneity within classes of patients identified as having complex care needs or non-complex needs. Discussion: By identifying factors contributing to complexity, this research has important implications for enhancing the management of patients with complex care needs.

Latina undergraduate students' barriers and facilitators of health are examined: Barriers to psychological health-separating from family, pressure to succeed, and racism; Barriers to physical health-lacking health insurance, and discomfort using campus sports facilities; and Facilitators of psychological health-membership in Latina student organizations, pride being the first family member to attend college, and ability to motivate other Latino/as to attend college. Using home remedies facilitated students' physical health. Practical recommendations for university personnel are discussed. ResumenSe examinan barreras y facilitadores de salud en estudiantes latinos de pregrado. Barreras para la salud psicológica: separación familiar, presión para el éxito, y racismo. Barreras para la salud física: falta de seguro de salud, e incomodidad usando instalaciones de deportes universitarios. Facilitadores de salud psicológica: membrecía en organizaciones estudiantiles latinas, orgullo de ser el primer universitario en su familia, y la habilidad de motivar otros latinos a ir a la universidad. Uso de remedios caseros facilitó la salud física de los estudiantes. Recomendaciones prácticas para personal universitario se presentan.

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