Zullig Leah L, Whitson Heather E, Hastings Susan N, Beadles Chris, Kravchenko Julia, Akushevich Igor, Maciejewski Matthew L
Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
J Gen Intern Med. 2016 Mar;31(3):329-37. doi: 10.1007/s11606-015-3512-2. Epub 2015 Sep 30.
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.
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.
患者复杂性通常通过计算多种慢性病（MCC）来衡量，而未考虑可能影响患者不良结局风险的背景因素。
我们的目标是开发一个复杂性概念模型，以解决已发表概念模型综述中发现的差距。
我们检索了2004年1月1日至2014年1月16日发表的英文MEDLINE论文。两名评审员独立评估摘要，所有作者通过迭代过程为概念模型的开发做出贡献。
从1606篇已识别的摘要中，选择了六个概念模型。通过参考文献回顾又识别出一个模型。每个模型都有优点，但几个构建要素未得到充分考虑：1）背景因素；2）复杂性动态；3）患者偏好；4）急性健康冲击；5）恢复力。我们的复杂性循环模型说明了在人际、组织和社区因素背景下，急性冲击与医疗事件、医疗服务可及性和利用、工作量和能力以及患者偏好之间的关系。
结论/启示：该模型可能为关于复杂性病因和变化、复杂性与患者结局之间关系以及改善复杂患者可改变因素的干预措施开发的研究提供信息。
