Definition of patient complexity in adults: A narrative review

Abstract

Background 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. Methods 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. Results 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. Conclusion 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.

Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review

“…SLENQ is specialized for patients with systemic lupus erythematosus. Nicolaus et al (2022) reviewed definitions of patient complexity, which included complexity defined with complexity measurement tools or conceptual models [ 11 ]. They concluded that there exists considerable heterogeneity in definition of patient complexity.…”

“…We searched two databases MEDLINE and CINAHL (see Supplementary S1 for search terms and search string). We also checked references from prior systematic reviews [ 11 , 12 , 13 ], and searched for references in the articles identified for inclusion, using Web of Science. If a study was not indexed in Web of Science ( ) (Accessed on 30 June 2022), we used Citationchaser [ 18 ] or Google scholar ( ) (Accessed on 30 June 2022).…”

“…Instead, several explanations with different scopes have been suggested [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. According to Nicolaus [ 11 ], patient complexity is a dynamic state in which biomedical, mental health, socioeconomic factors, and patient preferences are affected by each other. To deal with the patient complexity, conceptual models and complexity measurement tools are recognized.…”

Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program

“…In other words, not only the number of simultaneous chronic diseases influences health but also the severity of them added to several psychosocial factors ( 15 ). Complexity could be understood as a dynamic state in which socioeconomic, cultural, environmental, behavioral, and biological aspects operate as factors that hinder the understanding and management of health in certain people ( 16 ). Consequently, the interrelation between different factors may lead to interactions of diagnostic procedures or interventions, different treatment strategies, and multiple healthcare ( 16 ).…”

“…Complexity could be understood as a dynamic state in which socioeconomic, cultural, environmental, behavioral, and biological aspects operate as factors that hinder the understanding and management of health in certain people ( 16 ). Consequently, the interrelation between different factors may lead to interactions of diagnostic procedures or interventions, different treatment strategies, and multiple healthcare ( 16 ). That is why we distinguished between the complexity of the case, which refers to overlapping diseases and symptoms, and the complexity of care, which refers to the provision of healthcare and the joint involvement of systems and specialties.…”