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A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.

dc.contributor.author Akushevich, Igor
dc.contributor.author Beadles, Christopher A
dc.contributor.author Hastings, Susan Nicole
dc.contributor.author Kravchenko, J
dc.contributor.author Maciejewski, Matthew Leonard
dc.contributor.author Whitson, Heather Elizabeth
dc.contributor.author Zullig, Leah L
dc.coverage.spatial United States
dc.date.accessioned 2017-06-05T19:12:17Z
dc.date.available 2017-06-05T19:12:17Z
dc.date.issued 2016-03
dc.identifier https://www.ncbi.nlm.nih.gov/pubmed/26423992
dc.identifier 10.1007/s11606-015-3512-2
dc.identifier.uri http://hdl.handle.net/10161/14815
dc.description.abstract 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.
dc.language eng
dc.relation.ispartof J Gen Intern Med
dc.relation.isversionof 10.1007/s11606-015-3512-2
dc.subject complexity
dc.subject multimorbidity
dc.subject multiple chronic conditions
dc.subject patient goal
dc.subject patients
dc.subject resilience
dc.subject Health Services Accessibility
dc.subject Humans
dc.subject Models, Theoretical
dc.subject Patient Care
dc.subject Patient Preference
dc.title A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.
dc.type Journal article
pubs.author-url https://www.ncbi.nlm.nih.gov/pubmed/26423992
pubs.begin-page 329
pubs.end-page 337
pubs.issue 3
pubs.organisational-group Center for the Study of Aging and Human Development
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Duke Population Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Medicine
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine, Geriatrics
pubs.organisational-group Ophthalmology
pubs.organisational-group Physics
pubs.organisational-group Sanford School of Public Policy
pubs.organisational-group School of Medicine
pubs.organisational-group Social Science Research Institute
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Surgical Sciences
pubs.organisational-group Trinity College of Arts & Sciences
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 31
dc.identifier.eissn 1525-1497


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