Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool

Oliveira, Camila Almeida de; Weber, Bernardete; Santos, Jair Lício Ferreira; Zucoloto, Miriane Lucindo; Camargo, Lisa Laredo de; Zanetti, Ana Carolina Guidorizzi; Rzewuska, Magdalena; Marques, João Mazzoncini de Azevedo

doi:10.1371/journal.pone.0263702

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…1,8 The INTERMED has shown good psychometric validity in the primary health care population. 9 The reliability of the Japanese version of the INTERMED has been confirmed. 10 We have presented an instance of high patient-case complexity as follows.…”

Section: Introductionmentioning

confidence: 84%

Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment

Yokokawa¹,

Shikino²,

Kishi³

et al. 2022

IJGM

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This study aims to translate and ensure cross-cultural adaptation of a Japanese version of the INTERMED Self-Assessment Questionnaire (IMSA). Methods: A family medicine physician, a medical education specialist, a psychiatrist who prepared the Japanese version of the INTERMED, and two members of the INTERMED consortium were selected as committee members. We used the standard forward and backward translation method to translate the IMSA into Japanese. After translating the original IMSA into Japanese, all committee members discussed and reached a consensus on the proposed translation. The back-translation was performed by an English native professional translator who did not know the original text. We contacted the INTERMED consortium and asked them to review the conceptual equivalence of the back-translated Japanese version with the original version; after two reviews, the members approved the Japanese version. Thereafter, we conducted cognitive debriefings with four patients and nine healthcare professionals to ensure crosscultural adaptation. Results: The members of the INTERMED consortium approved the use of the Japanese version. We modified some expressions and words, while retaining the original meaning, to make it easier for Japanese patients to understand. Conclusion:We developed a Japanese version of the IMSA. A future study will investigate the construct criterion-related validity and the reliability of the scale.

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Section: Introductionmentioning

confidence: 84%

Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment

Yokokawa¹,

Shikino²,

Kishi³

et al. 2022

IJGM

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“…The INTERMED and IMSA 4 have been used in various populations such as primary care, 31 chronic pain, 13 orthopaedics 32 and mental healthcare settings 11 . The IMSA has been translated into several languages, 33 including French, German, Dutch, Spanish and Japanese, and a version for older people, INTERMED for the Elderly (IM‐E), has also been developed 34 .…”

Section: Discussionmentioning

confidence: 99%

Content validity testing of the INTERMED Self‐Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers

Dhiman,

Hall,

Crump

et al. 2024

Health Expectations

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BackgroundCare complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA.ObjectivesWe assessed the content validity of the INTERMEDS Self‐Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted.MethodsPatient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs.ResultsThree main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA.ConclusionsDespite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension.Patient or Public ContributionPatient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.

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“…While 9 out of 21 tools were used in primary care settings, the others were used only for inpatients. We identified 25 studies that investigated the correlation between patients’ complexity and health-related outcomes [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 ]. Two studies investigated the correlation between patients’ complexity with healthcare related costs [ 25 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review

Kaneko

Hanamoto²,

Yamamoto-Kataoka

et al. 2022

IJERPH

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Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.

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Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool

Cited by 9 publications

References 37 publications

Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment

Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment

Content validity testing of the INTERMED Self‐Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers

Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review

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