Nicolaus Stefanie, Crelier Baptiste, Donzé Jacques D, Aubert Carole E
Department of General Internal Medicine, Biel Hospital, Biel, Switzerland.
Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland.
J Multimorb Comorb. 2022 Feb 25;12:26335565221081288. doi: 10.1177/26335565221081288. eCollection 2022.
Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years.
We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model.
Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles.
A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
更好地识别复杂患者有助于改善对他们的护理。然而，患者复杂性本身的定义远非显而易见。我们进行了一项叙述性综述，以识别、描述和综合过去25年中使用的患者复杂性定义。
我们在PubMed上搜索了1995年1月至2020年9月期间以英文发表的定义患者复杂性的文章。我们将搜索范围扩展到所纳入文章的参考文献。我们评估了定义中呈现的领域，并将定义分类为基于（1）医学方面（如疾病数量）或（2）医学和/或非医学方面（如社会经济地位）。我们评估了该定义是否基于一种工具（如指数）或概念模型。
在83篇文章中，患者复杂性定义存在显著异质性。导致复杂性的领域包括健康、人口统计学、行为、社会经济因素、医疗保健系统、医疗决策和环境。30篇（36.1%）文章根据医学方面定义患者复杂性，53篇（63.9%）文章根据医学和/或非医学方面定义。36篇（43.4%）文章使用了一种工具，7篇（8.4%）文章使用了概念模型。
缺乏关于患者复杂性定义的共识。大多数定义在定义中纳入了非医学因素，强调了不仅要考虑医学方面，还要考虑非医学方面及其相互关系的重要性。
