Schaink Alexis K, Kuluski Kerry, Lyons Renée F, Fortin Martin, Jadad Alejandro R, Upshur Ross, Wodchis Walter P
Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Health, Toronto, ON, Canada.
Centre de Santé et de Services Sociaux de Chicoutimi, Chicoutimi, QC, Canada.
J Comorb. 2012 Oct 10;2:1-9. doi: 10.15256/joc.2012.2.15. eCollection 2012.
The path to improving healthcare quality for individuals with complex health conditions is complicated by a lack of common understanding of complexity. Modern medicine, together with social and environmental factors, has extended life, leading to a growing population of patients with chronic conditions. In many cases, there are social and psychological factors that impact treatment, health outcomes, and quality of life. This is the face of complexity. Care challenges, burden, and cost have positioned complexity as an important health issue. Complex chronic conditions are now being discussed by clinicians, researchers, and policy-makers around such issues as quantification, payment schemes, transitions, management models, clinical practice, and improved patient experience. We conducted a scoping review of the literature for definitions and descriptions of complexity. We provide an overview of complex chronic conditions, and what is known about complexity, and describe variations in how it is understood. We developed a Complexity Framework from these findings to guide our approach to understanding patient complexity. It is critical to use common vernacular and conceptualization of complexity to improve service and outcomes for patients with complex chronic conditions. Many questions still persist about how to develop this work with a health and social care lens; our framework offers a foundation to structure thinking about complex patients. Further insight into patient complexity can inform treatment models and goals of care, and identify required services and barriers to the management of complexity. Journal of Comorbidity 2012;2:1-9.
由于对复杂性缺乏共识，改善患有复杂健康状况个体的医疗质量之路充满曲折。现代医学连同社会和环境因素延长了人们的寿命，导致慢性病患者群体不断增加。在许多情况下，存在影响治疗、健康结局和生活质量的社会和心理因素。这就是复杂性的现状。护理挑战、负担和成本已使复杂性成为一个重要的健康问题。临床医生、研究人员和政策制定者现在围绕量化、支付方案、转诊、管理模式、临床实践以及改善患者体验等问题讨论复杂慢性病。我们对文献进行了范围综述，以获取复杂性的定义和描述。我们概述了复杂慢性病以及关于复杂性的已知情况，并描述了对其理解方式的差异。我们根据这些发现制定了一个复杂性框架，以指导我们理解患者复杂性的方法。使用关于复杂性的通用语言和概念化对于改善复杂慢性病患者的服务和结局至关重要。关于如何从健康和社会护理角度开展这项工作仍存在许多问题；我们的框架为构建对复杂患者的思考提供了一个基础。对患者复杂性的进一步洞察可为治疗模式和护理目标提供信息，并确定所需服务以及管理复杂性的障碍。《共病杂志》2012年；2：1 - 9。
