Open Access Open Access  Restricted Access Subscription or Fee Access

The complexity score: towards a clinically-relevant, clinician-friendly measure of patient multi-morbidity

Ross Edward Grant Upshur, Li Wang, Rahim Moineddin, Jason Nie, C. Shawn Tracy

Abstract


Rationale and Objectives: The population is rapidly aging and concurrent chronic diseases are increasing rapidly in the developed world. Health systems, clinicians, patients and care givers are challenged by the provision of care in this complex environment. Clinical assessment tools are needed to optimize management and facilitate informed decision-making by patients and care givers. We propose and evaluate a simple tool called the complexity score and evaluate its properties in terms of its distribution in a senior population in an academic family practice and assess its association with health services utilization.

Methods: We performed a retrospective chart audit of 2,450 patients aged 65 and older seen in an academic family practice in Ontario, Canada. We calculated the complexity score for each patient and analyzed the scores by age and gender. Using logistic and Poisson regression we evaluated the association of age, gender, marital status and complexity score with hospital admission (surgical and medical), emergency room visits and family practice visits.

Results: The complexity score of the practice was high. Overall median complexity score increased with age (65-69: 12, 85+: 16). Age, gender and complexity score were independently and statistically significantly associated with increased hospitalizations, emergency room visits and family physician visits. The OR for the complexity score was substantially increased for the highest complexity score in comparison to the reference group: OR ER visit: 6.5 (95% CI: 3.798-11.058), OR Hospitalization:12.08 (95% CI: 6.404-22.79). Age alone at most doubled the OR for these associations.

Conclusions: Multi-morbidity is common amongst older adults in an academic family practice. The complexity score is a simple to calculate measure that has the capacity to inform clinicians and patients on anticipated health service utilization. Further prospective studies are required to replicate the strong and significant associations described in this study. Further measurement tools that capture patient wellbeing and functional status are required to compliment this measure.


Keywords


Chronic illness, complexity, complexity score, family medicine, measurement tools, multimorbidity, older patients, person centered medicine

Full Text:

PDF

References


Tinetti, M.E., Fried, T.R. & Boyd, C.M. (2012). Designing health care for the most common chronic condition -multimorbidity. Journal of the American Medical Association 307 (23) 2493-2494.

Boyd, C.M., Darer, J., Boult, C., Fried, L.P., Boult, L. & Wu, A.W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. Journal of the American Medical Association 294 (6) 716-724.

Fried, T., Tinetti, M. & Ianonne, L. (2011). Primary care clinicians’ experiences with treatment decision making for older persons with multiple conditions. Archives of Internal Medicine 171, 75-80.

Tinetti, M.E., Bogardus, S.T.Jr. & Agostini, J.V. (2004). Potential pitfalls of specific disease guidelines for patients with multiple conditions. New England Journal of Medicine 351 (27) 2870-2874.

Denton, F.T. & Spencer, B.G. (2010). Chronic health conditions: Changing prevalence in an aging population and some implications for the delivery of health care services. Canadian Journal of Aging 29 (1) 11-21.

Mutasingwa, D.R., Ge, H. & Upshur, R.E. (2011). How applicable are clinical practice guidelines to elderly patients with co-morbidities? Canadian Family Physician 57 (7) e253-e262.

Bajcar, J., Wang, L., Moineddin, R., Nie, J., Tracy, C.S. & Upshur, R.E.G. (2010). From pharmac-otherapy to pharmaco prevention: Trends in prescribing to older adults in Ontario, Canada, 1997-2006. BMC Family Practice 11, 75.

Feinstein, A.R. (1987). Clinametrics. New Haven: Yale University Press.

Upshur, R.E. & Tracy, S. (2008). Chronicity and complexity: is what's good for the diseases always good for the patients? Canadian Family Physician 54 (12) 1655-1658.

Grant, R.W., Ashburner, J.M., Hong, C.C., Chang, Y., Barry, M.J. & Atlas, S.J. (2011). Defining patient complexity from the primary care physician's perspective: A cohort study. Annals of Internal Medicine 155 (12) 797-804.




DOI: http://dx.doi.org/10.5750/ijpcm.v2i4.315

Refbacks

  • There are currently no refbacks.