Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice.

By Nathan D. Shippee, N. Shah, Carl R. May, F. Mair, Victor M. Montori. Journal of Clinical Epidemiology, 2012

646 citations recorded by the source corpus.

OBJECTIVE To design a functional, patient-centered model of patient complexity with practical applicability to analytic design and clinical practice. Existing literature on patient complexity has mainly identified its components descriptively and in isolation, lacking clarity as to their combined functions in disrupting care or to how complexity changes over time. STUDY DESIGN AND SETTING The authors developed a cumulative complexity model, which integrates existing literature and emphasizes how clinical and social factors accumulate and interact to complicate patient care. A narrative literature review is used to explicate the model. RESULTS The model emphasizes a core, patient-level mechanism whereby complicating factors impact care and outcomes: the balance between patient workload of demands and patient capacity to address demands. Workload encompasses the demands on the patient's time and energy, including demands of treatment, self-care, and life in general. Capacity concerns ability to handle work (e.g., functional morbidity, financial/social resources, literacy). Workload-capacity imbalances comprise the mechanism driving patient complexity. Treatment and illness burdens serve as feedback loops, linking negative outcomes to further imbalances, such that complexity may accumulate over time. CONCLUSION With its components largely supported by existing literature, the model has implications for analytic design, clinical epidemiology, and clinical practice.

Subfields: Emergency Medical Services, Epidemiology, General Health Professions

View Paper: https://www.semanticscholar.org/paper/6af385f99b6c329da6bc20a63b4b4661de83c176

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In Emergency Medical Services

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Citations in the corpus

Implementation, context and complexity (2016, background): “[58], for example, applies NPT to situations in the home and outside of formal healthcare organisations, where ‘contexts’ are not so much organisational as organising and are distributed across informal social networks [59, 60].”
A Social Media Study on the Effects of Psychiatric Medication Use (2019, background): “Adopting a patient-centered approach (Shippee et al. 2012), in this paper, we seek to study the effects of these drugs as reflected and self-reported in the naturalistic social media activities of individuals.”
Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness (2014, background): “Second, Shippee et al’s., Cumulative Complexity Model [15] outlined relations between the work delegated by healthcare systems to patients (their burden of treatment), and the ways in which they can balance these burdens with capacity to meet the demands of delegated work.”
SEIPS 2.0: A human factors framework for studying and improving the work of healthcare professionals and patients (2013, background): “These include work on concepts of patient workload and complexity (Shippee et al. 2012) and self-management behaviour ‘in the wild’ (Hinder and Greenhalgh 2012).”
Preventing 30-day hospital readmissions: a systematic review and meta-analysis of randomized trials (2014, neutral): “Rated to increase patient workload (5)b 0.”