A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.
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BACKGROUND: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes. OBJECTIVE: Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models. DATA SOURCES: We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process. RESULTS: From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors. CONCLUSIONS/IMPLICATIONS: This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.
multiple chronic conditions
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Published Version (Please cite this version)10.1007/s11606-015-3512-2
Publication InfoZullig, Leah L; Whitson, Heather E; Hastings, Susan N; Beadles, Chris; Kravchenko, Julia; Akushevich, Igor; & Maciejewski, Matthew L (2016). A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. J Gen Intern Med, 31(3). pp. 329-337. 10.1007/s11606-015-3512-2. Retrieved from https://hdl.handle.net/10161/14815.
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Associate Research Professor in the Social Science Research Institute
Professor of Medicine
Professor in Population Health Sciences
Matt Maciejewski, PhD is a Professor in the Department of Population Health Sciences. He is also a Senior Research Career Scientist and Director of the Non-randomized Design Lab in the Center of Innovation to Accelerate Discovery and Practice Transformation at the Durham VA Medical Center. Matt also holds Adjunct Professor appointments in the Schools of Public Health and Pharmacy at the University of North Carolina at Chapel Hill. He has received funding from NIDA, CMS, AHRQ, VA
Professor of Medicine
Dr. Whitson's research is focused on improving care options and resilience for people with multiple chronic conditions. In particular, she has interest and expertise related to the link between age-related changes in the eye and brain (e.g., How does late-life vision loss impact the aging brain or cognitive outcomes? Is Alzheimer's disease associated with distinctive changes in the retina, and could such changes help diagnose Alzheimer's disease early in its course?). Dr. Whits
Associate Professor in Population Health Sciences
Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is an Associate Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address the reduction of healthcare disparities, improving cancer care delivery and quality,
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