Defining patient complexity from the primary care physician's perspective: A cohort study

  • Grant R
  • Ashburner J
  • Hong C
 et al. 
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Abstract

BACKGROUND Patients with complex health needs are increasingly the focus of health system redesign. OBJECTIVE To characterize complex patients, as defined by their primary care physicians (PCPs), and to compare this definition with other commonly used algorithms. DESIGN Cohort study. SETTING 1 hospital-based practice, 4 community health centers, and 7 private practices in a primary care network in the United States. PARTICIPANTS 40 physicians who reviewed a random sample of 120 of their own patients. MEASUREMENTS After excluding patients for whom they were not directly responsible, PCPs indicated which of their patients they considered complex. These patients were characterized, independent predictors of complexity were identified, and PCP-defined complexity was compared with 3 comorbidity-based methods (Charlson score, Higashi score, and a proprietary Centers for Medicare & Medicaid Services algorithm). RESULTS Physicians identified 1126 of their 4302 eligible patients (26.2%) as complex and assigned a mean of 2.2 domains of complexity per patient (median, 2.0 [interquartile range, 1 to 3]). Mental health and substance use were identified as major issues in younger complex patients, whereas medical decision making and care coordination predominated in older patients (P

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