The Complexity of Measuring Clinical Complexity
Authors: Barbara J. Turner, Leona Cuttler
Journal: Annals of Internal Medicine (2011)

Editorials20 December 2011The Complexity of Measuring Clinical ComplexityBarbara J. Turner, MD, MSEd, MA and Leona Cuttler, MDBarbara J. Turner, MD, MSEd, MAFrom University of Texas Health Science Center at San Antonio and University Health System, San Antonio, TX 78229, and Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, OH 44106. and Leona Cuttler, MDFrom University of Texas Health Science Center at San Antonio and University Health System, San Antonio, TX 78229, and Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, OH 44106.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-155-12-201112200-00009 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Measuring patient complexity in the ambulatory care setting has significant implications for patients, physicians, insurers, and policymakers and, consequently, is the subject of vigorous debate. The increasing prevalence of chronic diseases and multiple comorbid conditions in both adults and children (1, 2) is producing many more patients with complex clinical needs. Managing these patients requires greater clinician effort, increased health care and non–health care resources, and substantial caregiver and community support. Unless the demanding care of complex patients is appropriately considered and compensated, clinicians have a powerful incentive to select healthier patients and to spurn those who are more difficult ...References1. Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med. 2007;22 Suppl 3 391-5. [PMID: 18026807] CrossrefMedlineGoogle Scholar2. Van Cleave J, Gortmaker SL, Perrin JM. Dynamics of obesity and chronic health conditions among children and youth. JAMA. 2010;303:623-30. [PMID: 20159870] CrossrefMedlineGoogle Scholar3. Werner RM, Greenfield S, Fung C, Turner BJ. Measuring quality of care in patients with multiple clinical conditions: summary of a conference conducted by the Society of General Internal Medicine. J Gen Intern Med. 2007;22:1206-11. [PMID: 17516106] CrossrefMedlineGoogle Scholar4. Werner RM, Asch DA. Clinical concerns about clinical performance measurement. Ann Fam Med. 2007;5:159-63. [PMID: 17389541] CrossrefMedlineGoogle Scholar5. Weiss KB. Managing complexity in chronic care: an overview of the VA state-of-the-art (SOTA) conference. J Gen Intern Med. 2007;22 Suppl 3 374-8. [PMID: 18026804] CrossrefMedlineGoogle Scholar6. Safford MM, Allison JJ, Kiefe CI. Patient complexity: more than comorbidity. the vector model of complexity. J Gen Intern Med. 2007;22 Suppl 3 382-90. [PMID: 18026806] CrossrefMedlineGoogle Scholar7. Friedman B, Jiang HJ, Elixhauser A, Segal A. Hospital inpatient costs for adults with multiple chronic conditions. Med Care Res Rev. 2006;63:327-46. [PMID: 16651396] CrossrefMedlineGoogle Scholar8. Ash AS, Zhao Y, Ellis RP, Schlein Kramer M. Finding future high-cost cases: comparing prior cost versus diagnosis-based methods. Health Serv Res. 2001;36:194-206. [PMID: 16148969] MedlineGoogle Scholar9. Min LC, Wenger NS, Fung C, Chang JT, Ganz DA, Higashi T, et al. Multimorbidity is associated with better quality of care among vulnerable elders. Med Care. 2007;45:480-8. [PMID: 17515774] CrossrefMedlineGoogle Scholar10. Turner BJ, Hollenbeak CS, Weiner M, Ten Have T, Tang SS. Effect of unrelated comorbid conditions on hypertension management. Ann Intern Med. 2008;148:578-86. [PMID: 18413619] LinkGoogle Scholar11. Grant RW, Ashburner JM, Hong CC, Chang Y, Barry MJ, Atlas SJ. Defining patient complexity from the primary care physician's perspective. A cohort study. Ann Intern Med. 2011;155:797-804. LinkGoogle Scholar12. O'Connor PG, Nyquist JG, McLellan AT. Integrating addiction medicine into graduate medical education in primary care: the time has come. Ann Intern Med. 2011;154:56-9. [PMID: 21200039] LinkGoogle Scholar13. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55:780-91. [PMID: 17493201] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Barbara J. Turner, MD, MSEd, MA; Leona Cuttler, MDAffiliations: From University of Texas Health Science Center at San Antonio and University Health System, San Antonio, TX 78229, and Case Western Reserve University and Rainbow Babies and Children's Hospital, Cleveland, OH 44106.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2615.Corresponding Author: Barbara J. Turner, MD, MSEd, MA, 7411 John Smith Road, Suite 1050, San Antonio, TX 78229; e-mail, [email protected]edu.Current Author Addresses: Dr. Turner: 7411 John Smith Road, Suite 1050, San Antonio, TX 78229.Dr. Cuttler: The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Suite 737, Mailstop RB&C 6004, Cleveland, OH 44106. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDefining Patient Complexity From the Primary Care Physician's Perspective Richard W. Grant , Jeffrey M. Ashburner , Clemens S. Hong , Yuchiao Chang , Michael J. Barry , and Steve J. Atlas Metrics Cited byDisproportionate multimorbidity among veterans in middle ageRisk Stratification in Primary Care: Value-Based Contributions of Provider AdjudicationDiagnostic Reasoning in Internal Medicine. 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