Definition of patient complexity in adults: A narrative review.

Nicolaus, Stefanie; Crelier, Baptiste; Donzé, Jacques D; Aubert, Carole E (2022). Definition of patient complexity in adults: A narrative review. Journal of Multimorbidity and Comorbidity, 12, p. 26335565221081288. SAGE 10.1177/26335565221081288

Nicolaus_JMultimorbComorb_2022.pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial (CC-BY-NC).

Download (820kB) | Preview

Background: Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years.

Methods: We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model.

Results: Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decisionmaking, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles.

Conclusion: A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated nonmedical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.

Item Type:

Journal Article (Review Article)


04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Crelier, Baptiste, Aubert, Carole Elodie


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services






[4] Swiss National Science Foundation




Doris Kopp Heim

Date Deposited:

07 Apr 2022 16:47

Last Modified:

05 Dec 2022 16:18

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

complex, complexity, patient complexity, multimorbidity




Actions (login required)

Edit item Edit item
Provide Feedback