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. 2016 Mar;31(3):329-37.
doi: 10.1007/s11606-015-3512-2. Epub 2015 Sep 30.

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

Leah L Zullig  1   2   3   4 , Heather E Whitson  5   4   6   7   8 , Susan N Hastings  1   5   4   6   7 , Chris Beadles  4   9 , Julia Kravchenko  4   10 , Igor Akushevich  4   11 , Matthew L Maciejewski  12   13   14
Affiliations

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

Leah L Zullig et al. J Gen Intern Med. 2016 Mar.

Abstract

Background: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes.

Objective: Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models.

Data sources: We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process.

Results: From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors.

Conclusions/implications: This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.

Keywords: complexity; multimorbidity; multiple chronic conditions; patient goal; patients; resilience.

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Figures

Figure 1
Figure 1
PRISMA Flow Diagram. Legend. Specific search strategy: ((multiple[tiab] AND (“Chronic Disease"[Mesh] OR "Comorbidity"[Mesh] OR comorbidity[tiab] OR comorbidities[tiab] OR comorbid[tiab] OR co-morbid[tiab])) OR "patient complexity"[tiab] OR "multiple chronic comorbidities"[tiab] OR "multiple chronic conditions"[tiab] OR "multiple chronic disease"[tiab] OR "multiple chronic diseases"[tiab]) AND (("Models, Theoretical"[Mesh] OR framework[tiab] OR model[tiab] OR models[tiab]) NOT "Models, Statistical"[Mesh]) NOT (animals[mh] NOT humans[mh]) AND English[la] AND ("2004"[Date - Publication] : "3000"[Date - Publication]).
Figure 2
Figure 2
Within-person changes over time in capacity and workload
Figure 3
Figure 3
The Cycle of Complexity
See this image and copyright information in PMC

Comment in

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