A consensus for the development of a vector model to assess clinical complexity

Abstract

The progressive rise in multimorbidity has made management of complex patients one of the most topical and challenging issues in medicine, both in clinical practice and for healthcare organizations. To make this easier, a score of clinical complexity (CC) would be useful. A vector model to evaluate biological and extra-biological (socio-economic, cultural, behavioural, environmental) domains of CC was proposed a few years ago. However, given that the variables that grade each domain had never been defined, this model has never been used in clinical practice. To overcome these limits, a consensus meeting was organised to grade each domain of CC, and to establish the hierarchy of the domains. A one-day consensus meeting consisting of a multi-professional panel of 25 people was held at our Hospital. In a preliminary phase, the proponents selected seven variables as qualifiers for each of the five above-mentioned domains. In the course of the meeting, the panel voted for five variables considered to be the most representative for each domain. Consensus was established with 2/3 agreement, and all variables were dichotomised. Finally, the various domains were parametrized and ranked within a feasible vector model. A Clinical Complexity Index was set up using the chosen variables. All the domains were graphically represented through a vector model: the biological domain was chosen as the most significant (highest slope), followed by the behavioural and socio-economic domains (intermediate slope), and lastly by the cultural and environmental ones (lowest slope). A feasible and comprehensive tool to evaluate CC in clinical practice is proposed herein.

The Manage Care Model – Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes

“…Three consensus meetings in February, April and May 2016 were set up to iteratively develop the model using feedback of the MANAGE CARE Study Group. This is in line with previous consensus meetings [21][22][23]. The extensive list of unmet needs was reviewed by the MANAGE CARE Study Group to identify requirements and potential dimensions for the new model.…”

Clinical complexity and hospital admissions in the December holiday period

“…Overall, 80 beds are present in the internal medicine unit, and most of the patients are admitted from the local Emergency department. The CC index used in the study (S1 Fig) was developed through a previous consensus meeting [13].…”

“…The CC was assessed with a CC index that was previously developed involving a multi-professional panel of 25 individuals, including physicians specialized in different areas, general practitioners, nurses, one biostatistician, one patient, and one medical student. In brief, the developmental process of the consensus meeting included the pre-identification of a number of variables capable of qualifying, according to current evidence, each CC domain, and a modified Delphi process through which only five variables per each CC domain were identified [13]. CC components include biological, socioeconomic, cultural, behavioral, and environmental domains (S1 Fig).…”

“…As a part of the ongoing San MAtteo Complexity (SMAC) study, the aim of the present work was to verify whether patients admitted to the hospital over the December holiday period had greater CC, as measured with a mathematical model [9] that has been recently parametrized [13] in the form of a reproducible index [14].…”

Reproducibility in the Assessment of the Components of a Clinical Complexity Index

“…To allow its use, each vector has been graded following a consensus meeting during which the five most representative variables of each CC domain were selected. 6 However, a score made of a series of variables could be a source of variability. For this reason, we have performed an interobserver agreement study.…”