Patient Complexity Characteristics in the Hospital Setting

Crelier, Baptiste; Streit, Sven; Donzé, Jacques D (2018). Patient Complexity Characteristics in the Hospital Setting. American Journal of Accountable Care, 9(3), pp. 3-8. Managed Care & Healthcare Communications, LLC

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OBJECTIVES:
To identify the characteristics of patients, diagnoses, treatments, processes, and communication that account for patient complexity as described by general internists in a hospital setting, as well as the frequency of patient complexity in the hospital setting.

STUDY DESIGN:
Multicenter cross-sectional survey at the departments of medicine of 3 large hospitals in Switzerland between July 2015 and October 2015.

METHODS:
A total of 111 general internists from 3 hospitals returned the survey, yielding a response rate of 53%. The survey had 21 closed-ended questions about the influence on patient complexity of factors in 4 categories of characteristics: patients’ characteristics, comorbidities and diagnoses, therapy, and hospital structure and process.

RESULTS:
The proportion of patients estimated to be complex was 42%. Multi­morbidity was the characteristic most frequently considered to influence patient complexity (95%; n = 106), followed by multiple therapy changes (94%; n = 104), psychiatric diseases (91%; n = 101), alcohol or drug abuse 91%; n = 101), communication barriers (89%; n = 99), several prescriptions (89%; n = 99), patient aggressiveness (88%; n = 98), therapy compliance (88%; n = 97), communication among divisions within the same hospital (85%; n = 94), and care coordination among providers (85%;n = 92).

CONCLUSIONS:
Several factors were identified as playing a role in hospital patient complexity, including multimorbidity, multiple therapy changes, psychiatric diseases, alcohol or drug abuse, and communication barriers.

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