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

Journal Article (Review)

Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes.Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models.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.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.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.

Full Text

Duke Authors

Cited Authors

  • Zullig, LL; Whitson, HE; Hastings, SN; Beadles, C; Kravchenko, J; Akushevich, I; Maciejewski, ML

Published Date

  • March 2016

Published In

Volume / Issue

  • 31 / 3

Start / End Page

  • 329 - 337

PubMed ID

  • 26423992

Electronic International Standard Serial Number (EISSN)

  • 1525-1497

International Standard Serial Number (ISSN)

  • 0884-8734

Digital Object Identifier (DOI)

  • 10.1007/s11606-015-3512-2

Language

  • eng