A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development

Area of Science:

• Health Services Research
• Patient Complexity Modeling
• Conceptual Model Development

Background:

• Current operationalization of patient complexity often relies on counting multiple chronic conditions (MCC).
• This approach overlooks crucial contextual factors influencing patient risk for adverse outcomes.
• Existing conceptual models of complexity have identified gaps in fully addressing these factors.

Purpose of the Study:

• To develop an improved conceptual model of patient complexity.
• To address identified gaps in existing published conceptual models.
• To create a model that incorporates a broader range of factors influencing patient risk.

Main Methods:

• Systematic literature search of MEDLINE for conceptual models of patient complexity (2004-2014).
• Independent review of abstracts by two researchers.
• Iterative development of a new conceptual model by all authors.

Main Results:

• Six conceptual models were identified from 1606 abstracts, with one additional model found via reference review.
• Key constructs not fully considered in existing models included contextual factors, dynamics of complexity, patient preferences, acute health shocks, and resilience.
• The developed Cycle of Complexity model integrates acute events, healthcare utilization, capacity, patient preferences, and interpersonal, organizational, and community factors.

Conclusions:

• The new Cycle of Complexity model offers a more comprehensive understanding of patient complexity.
• This model can inform future research on the causes and changes in patient complexity.
• It provides a framework for investigating the link between complexity and patient outcomes and for developing targeted interventions.