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Multicenter Study
. 2018 Apr 16;13(4):e0195805.
doi: 10.1371/journal.pone.0195805. eCollection 2018.

The complexity of patients hospitalized in Internal Medicine wards evaluated by FADOI-COMPLIMED score(s). A hypothetical approach

Erminio Bonizzoni  1 , Gualberto Gussoni  2 , Giancarlo Agnelli  3 , Raffaele Antonelli Incalzi  4 , Moira Bonfanti  5 , Franco Mastroianni  6 , Marco Candela  7 , Carlotta Franchi  8 , Stefania Frasson  2 , Antonio Greco  9 , Micaela La Regina  10 , Roberta Re  11 , Giorgio Vescovo  12 , Mauro Campanini  11
Affiliations
Multicenter Study

The complexity of patients hospitalized in Internal Medicine wards evaluated by FADOI-COMPLIMED score(s). A hypothetical approach

Erminio Bonizzoni et al. PLoS One. .

Abstract

Objectives: The aim of this study is to develop a new predictive model to measure complexity of patients in medical wards.

Setting: 29 Internal Medicine departments in Italy.

Materials and methods: The study cohort was made of 541 consecutive patients hospitalized for any cause, aged more than 40 years and with at least two chronic diseases. First, we applied a hierarchical cluster analysis and the principal component analysis (PCA) to a panel of questionnaires [comorbidity (Charlson, CIRS), clinical stability (MEWS), social frailty (Flugelman), cognitive dysfunction (SPSMQ), depression (5-item GDS), functional dependence (ADL, IADL, Barthel), risk of sore threats (Exton-Smith scale), nutrition (MNA), pain (NRPS), adherence to therapy (Morisky scale)], in order to select domains informative for the definition of complexity. The following step was to create the score(s) needed to quantify it.

Results: Two main clusters were identified: the first includes 7 questionnaires whose common denominator is dependence and frailty, the second consists of 3 questionnaires representative of comorbidity. Globally, they account for about 70% of the total variance (55.2% and 13.8%, respectively). The first principal component was simplified in "Complimed Score 1" (CS1) as a recalibrated average between the Barthel Index and the Exton Smith score, whereas the second cluster was approximated to "Complimed Score 2" (CS2), by using the Charlson score only.

Conclusions: Complexity is a two-dimensional clinical phenomenon. The FADOI-Complimed Score(s) is a new tool useful for the routine evaluation of complexity in medical patients, simple to use and taking around 10 minutes to complete.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow-chart of the methods used for the study.
Fig 2
Fig 2. Dendogram of the cluster analysis.
Fig 3
Fig 3. Scree plot for the eigenvalues of the correlation matrix.
Fig 4
Fig 4. Scores of the questionnaires for the two principal components.
Twenty-five percent, 50%, and 100% variance circles are displayed in the plot.
Fig 5
Fig 5. Relationship between principal component 1 and the Multidimensional Prognostic Index (MPI).
Regression line, 95% prediction limits, 95% probability ellipse and residuals are displayed in the plot.
See this image and copyright information in PMC

References

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