Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity

Abstract

Summary Background Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine. Objective The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on infectious disease domain. The measurement model was adapted and modified to healthcare domain. Methods Three clinical Infectious Disease teams were observed, audio-recorded and transcribed. Each team included an Infectious Diseases expert, one Infectious Diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding process and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen’s kappa. Results The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions. Conclusion The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.

Identifying complexity in infectious diseases inpatient settings: An observation study

“…Also, we have used the clinical complexity model to identify the specific complexity factors relevant in the ID domain. The observation data from this study was partially used to modify and create the conceptual model of patient and task complexity, which is described in more detail in Methods of Information in Medicine 25 . This conceptual model consists of patient and task complexity contributing factors (Table 2) that were used to code the transcripts.…”

“…diagnostic uncertainty, perceived difficulty, treatment unpredictability, and similarity, were obtained from the Liu et al task complexity model. 21, 25 …”

“…25 In the present study, we conducted provider observations to identify the specific CCFs in the ID domain and their relationship to perceived complexity.…”

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“…1 Therefore, therapeutic decisions are often made in situations of substantial uncertainty, potentially resulting in inappropriate testing and treatment.…”