Identifiers, or “Red Flags,” of Complexity and Need for Integrated Care
Section snippets
Stepwise screening and assessment model for case complexity
In psychiatric epidemiology, for reasons of cost containment, a two-step procedure is generally used. The COMPRI-INTERMED model may serve as an illustration (Fig. 1) [2]. The Complexity Prediction Instrument (COMPRI), an identifier of complexity and a predictor for negative health care outcomes (Fig. 2) [3], [4], [5] precedes the more comprehensive assessment of complexity in terms of care risks and care needs; the INTERMED method [6], [7].
Following complexity screening with the COMPRI, the
Factors influencing the use of complexity indicators
A medical team's awareness of the development of integrated care for complex patients is the most important factor. The recognition that fragmented care for a subgroup of patients served—the complex medically ill—does not deliver adequate services is crucial. Without recognition, there can be no integrated care, and no integrated care is possible without appropriate reimbursement, which is the second factor influencing the use of complexity indicators. It therefore is of utmost importance that
From traditional to integrated care
When a physician encounters a patient who has a clinical problem that does not belong to his area of expertise, and action seems appropriate, the standard medical procedure is to consult a colleague. The authors, however, have demonstrated that such classic ad hoc models are not very effective in identifying and treating certain patients (eg, those who have psychiatric morbidity in the general hospital). Consultations generally are limited compared with the prevalence of a given problem (eg,
Disease-specific versus complexity-specific approaches
The PHQ is a self-reported questionnaire derived from the psychiatric diagnostic tool for primary care, the Primary Care Evaluation of Mental Disorders, based on the Diagnostic and Statistical Manual of Mental Disorders [24]. The PHQ is used as a tool to determine action (Box 1), a major advantage of disease-management programs as compared with the traditional consultation model.
The question arises: should identifiers be disease-specific—as with the PHQ for depression—or focus on behaviors that
Identifiers of complex medically ill patients
The foregoing discussion indicates that medical teams should determine identifiers of their complex patients derived from the clinical characteristics of the population they serve. They should use their existing administrative and clinical monitoring system to provide “red flags” as identifiers of complex patients. Such identifiers would be (1) clinical characteristics, such as negative medical outcomes (eg, HbA1c levels in diabetes) or complications (eg, kidney disease in cardiovascular
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