Nelson Michelle L A, Hanna Elizabeth, Hall Stephen, Calvert Michael
Bridgepoint Hospital, Sinai Health System, Toronto, ON, Canada.
J Comorb. 2016 Mar 4;6(2):35-41. doi: 10.15256/joc.2016.6.63. eCollection 2016.
Approximately 80% of people who survive a stroke have on average five other conditions and a wide range of psychosocial issues. Attention to biopsychosocial issues has led to the identification of 'complex patients'. No single definition of 'patient complexity' exists; therefore, applied health researchers seek to understand 'patient complexity' as it relates to a specific clinical context.
To understand how 'patient complexity' is conceptualized by clinicians, and to position the findings within the existing literature on patient complexity.
A qualitative descriptive approach was utilized. Twenty-three stroke rehabilitation clinicians participated in four focus groups.
Five elements of patient complexity were identified: medical/functional issues, social determinant factors, social/family support, personal characteristics, and health system factors. Using biopsychosocial factors to identify complexity results in all patients being complex; operationalization of the definition led to the identification of systemic elements. A disconnect between acute, inpatient rehabilitation and community services was identified as a trigger for increased complexity.
Patient complexity is not a dichotomous state. If applying existing complexity definitions, all patients are complex. This study extends the understanding by suggesting a structural element of complexity from manageable to less manageable complexity based on ability to discharge.
中风幸存者中约80%的人平均还患有其他五种疾病，并存在广泛的社会心理问题。对生物心理社会问题的关注促使了“复杂患者”的识别。目前尚无“患者复杂性”的单一明确定义；因此，应用健康研究人员试图了解与特定临床背景相关的“患者复杂性”。
了解临床医生如何对“患者复杂性”进行概念化，并将研究结果置于现有的关于患者复杂性的文献中。
采用定性描述性方法。23名中风康复临床医生参加了四个焦点小组。
确定了患者复杂性的五个要素：医疗/功能问题、社会决定因素、社会/家庭支持、个人特征和卫生系统因素。使用生物心理社会因素来识别复杂性会导致所有患者都被视为复杂患者；定义的操作化导致了系统要素的识别。急性住院康复与社区服务之间的脱节被确定为复杂性增加的触发因素。
患者复杂性并非二元状态。如果应用现有的复杂性定义，所有患者都是复杂的。本研究通过基于出院能力提出从可管理复杂性到较难管理复杂性的复杂性结构要素，扩展了对这一概念的理解。
