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

Publication ,  Journal Article
Zullig, LL; Whitson, HE; Hastings, SN; Beadles, C; Kravchenko, J; Akushevich, I; Maciejewski, ML
Published in: J Gen Intern Med
March 2016

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.

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Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

March 2016

Volume

31

Issue

3

Start / End Page

329 / 337

Location

United States

Related Subject Headings

  • Patient Preference
  • Patient Care
  • Models, Theoretical
  • Humans
  • Health Services Accessibility
  • General & Internal Medicine
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Chicago
ICMJE
MLA
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Zullig, L. L., Whitson, H. E., Hastings, S. N., Beadles, C., Kravchenko, J., Akushevich, I., & Maciejewski, M. L. (2016). A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. J Gen Intern Med, 31(3), 329–337. https://doi.org/10.1007/s11606-015-3512-2
Zullig, Leah L., Heather E. Whitson, Susan N. Hastings, Chris Beadles, Julia Kravchenko, Igor Akushevich, and Matthew L. Maciejewski. “A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.J Gen Intern Med 31, no. 3 (March 2016): 329–37. https://doi.org/10.1007/s11606-015-3512-2.
Zullig LL, Whitson HE, Hastings SN, Beadles C, Kravchenko J, Akushevich I, et al. A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. J Gen Intern Med. 2016 Mar;31(3):329–37.
Zullig, Leah L., et al. “A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.J Gen Intern Med, vol. 31, no. 3, Mar. 2016, pp. 329–37. Pubmed, doi:10.1007/s11606-015-3512-2.
Zullig LL, Whitson HE, Hastings SN, Beadles C, Kravchenko J, Akushevich I, Maciejewski ML. A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development. J Gen Intern Med. 2016 Mar;31(3):329–337.
Journal cover image

Published In

J Gen Intern Med

DOI

EISSN

1525-1497

Publication Date

March 2016

Volume

31

Issue

3

Start / End Page

329 / 337

Location

United States

Related Subject Headings

  • Patient Preference
  • Patient Care
  • Models, Theoretical
  • Humans
  • Health Services Accessibility
  • General & Internal Medicine
  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1103 Clinical Sciences