Patient care complexity as perceived by primary care physicians.

Abstract

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.

The complex patient: A concept clarification

“…With the goal of improving care, these scales seek to become more precise assessment tools. The articles reviewed also reflect aims to improve quality of patient care (Werner et al, 2007), advance diagnosis and treatment (Fried et al, 2004), facilitate better symptom management (Spirig et al, 2005), reduce the costs of patient care (Vogeli et al, 2007), maximize treatment plans (Safford et al, 2007), advocate for integrated care for persons not diseases (Peek, 2009), improve coordinated care decision- (Latour et al, 2007), assess risk (Rosen et al, 2003), and "reimburse providers appropriately for their care" (P144) (Mount et al, 2015). With varying levels of specificity (along with degrees of success), these scales maintain a certain level of conceptual confusion around the concept of the "complex patient.…”

“…Simply, they argue that patient complexity is the “overall impact of the different diseases in an individual taking into account their severity and other health‐related attributes” (P137) (Valderas et al, ). Most recently, Mount et al () conducted an action research study to “enhance an explicit understanding of complexity,” (P137) where they identified that neither multiple diagnoses nor mental health issues were determining factors in primary care physicians' categorizations of complex patients. Rather, they found that physicians labeled patients complex if they “required excessive” attention and were not “able to effectively participate in their personal care” (P137).…”

“…A clear, shared and conscious agreement on this concept can act as a needed bridge to assist clear communication in multidisciplinary care. For that reason, Peek et al () argue that clarifying this concept serves a very practical need and Mount et al () suggest that “accurately defining complexity is essential to create interventions to improve patient care” (P138). We argue that there is also an empirical and theoretical need to think critically about this concept and engage with the literature published in health sciences.…”

Theoretical framework construction on care complexity in Chinese hospitals: A grounded theory study

“…However, the concept of care complexity has generally been confused with “intensity of nursing” and “nursing workload,” which includes the severity of illness, nursing dependence levels, nursing complexity, and nursing hours [2]. Previous studies [[3], [4], [5], [6], [7], [8]] have evaluated the different aspects of nursing difficulty. Moreover, Jonge [3] described care complexity as the represention of the aspects of care delivery, namely, the involvement of multiple systems and specialties that require interdisciplinary communication to be effective.…”

Using the SBAR4 model for Management of a Patient with Complex Comorbidities in the Primary Care setting – A Case Study

“…An interplay of these factors determines the level of self-activation in an individual that correlates to the ability to manage one's health or adhere to recommended lifestyle and care plans. 4,5 e following are some examples illustrating common presentations in practice within the various domains in a complex patient. often poorly coordinated.…”