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

Zullig, Leah L

Whitson, Heather E

Hastings, Susan N

Beadles, Chris

Kravchenko, Julia

Akushevich, Igor

Maciejewski, Matthew L

United States

2017-06-05T19:12:17Z

2017-06-05T19:12:17Z

2016-03

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.

https://www.ncbi.nlm.nih.gov/pubmed/26423992

10.1007/s11606-015-3512-2

1525-1497

https://hdl.handle.net/10161/14815

eng

Springer Science and Business Media LLC

J Gen Intern Med

10.1007/s11606-015-3512-2

complexity

multimorbidity

multiple chronic conditions

patient goal

patients

resilience

Health Services Accessibility

Humans

Models, Theoretical

Patient Care

Patient Preference

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

Journal article

Zullig, Leah L|0000-0002-6638-409X

Whitson, Heather E|0000-0002-8417-4846

Hastings, Susan N|0000-0002-5750-8820

Maciejewski, Matthew L|0000-0003-1765-5938

https://www.ncbi.nlm.nih.gov/pubmed/26423992

329

337

3

Center for the Study of Aging and Human Development

Clinical Science Departments

Duke

Duke Cancer Institute

Duke Population Research Institute

Institutes and Centers

Institutes and Provost's Academic Units

Medicine

Medicine, General Internal Medicine

Medicine, Geriatrics

Ophthalmology

Physics

Sanford School of Public Policy

School of Medicine

Social Science Research Institute

Surgery

Surgery, Surgical Sciences

Trinity College of Arts & Sciences

University Institutes and Centers

Published

31