Featured Research

from universities, journals, and other organizations

What makes patients complex? Ask their primary care physicians

Date:
December 19, 2011
Source:
Massachusetts General Hospital
Summary:
Being able to define and measure patient complexity has important implications for how care is organized, how physicians and health care systems are paid, and how resources are allocated. Researchers have found that primary care physicians define patient complexity using a broader range of factors – including mental health, social factors and financial issues – than do commonly used approaches based only on diagnoses and prior costs.

As Americans live longer with multiple medical conditions, managing their care is becoming increasingly challenging. Being able to define and measure patient complexity has important implications for how care is organized, how physicians and health care systems are paid, and how resources are allocated.

In an article in the December 20 Annals of Internal Medicine, a team of Massachusetts General Hospital (MGH) researchers report finding that primary care physicians define patient complexity using a broader range of factors -- including mental health, social factors and financial issues -- than do commonly used approaches based only on diagnoses and prior costs.

"Simply counting the number of co-morbid conditions does not really capture whether a patient is complex," explains Richard W. Grant, MD, MPH, the paper's lead author. "All primary care physicians can point to patients of theirs with very complicated medical histories who are relatively straightforward to manage, whereas other patients can be a real challenge despite relatively few medical diagnoses. Our results emphasize the importance of social and behavioral contexts that can create important barriers to delivering high-quality primary care."

The study enrolled 40 primary care physicians from 12 MGH-affiliated practices and community health centers. Participating physicians used a web-based tool to review a list of 120 of their own patients and indicated those who, in their view, were complex. For those complex patients, they were asked to indicate which of five domains -- medical decision-making, coordinating care, mental health or substance abuse problems, health-related behaviors, and social or economic circumstances -- were involved in that determination.

The authors found that primary care physicians designated about one-quarter of their patients as complex -- with older, more experienced physicians and those working in community health centers reporting higher proportions of complex patients. Compared to non-complex patients, complex patients were older, more often women, and had more clinic visits to many different providers. Complex patients were also prescribed more medicines -- including prescriptions for anti-psychotic medicines -- were more likely to miss appointments, and were more likely to live in neighborhoods with lower income and educational levels. The authors then found that the results of physician assessment differed substantially from those of other common methods for assessing complexity.

"Managing complex patients requires greater clinician effort, increased health care resources, and substantial family and community support," says Grant, who recently joined the division of Research at Kaiser Permanente Northern California. "In order to redesign our health care systems to more effectively care for complex patients, we need a better handle on exactly who they are. By asking primary care physicians about their experiences with their own patients in a systematic and quantitative way, we were able to bring out the importance of social and behavioral factors, in addition to specific medical problems. This work may help guide efforts to redesign health care systems so that we can deliver high quality, cost-effective care tailored to individual patient needs."


Story Source:

The above story is based on materials provided by Massachusetts General Hospital. Note: Materials may be edited for content and length.


Cite This Page:

Massachusetts General Hospital. "What makes patients complex? Ask their primary care physicians." ScienceDaily. ScienceDaily, 19 December 2011. <www.sciencedaily.com/releases/2011/12/111219203903.htm>.
Massachusetts General Hospital. (2011, December 19). What makes patients complex? Ask their primary care physicians. ScienceDaily. Retrieved July 30, 2014 from www.sciencedaily.com/releases/2011/12/111219203903.htm
Massachusetts General Hospital. "What makes patients complex? Ask their primary care physicians." ScienceDaily. www.sciencedaily.com/releases/2011/12/111219203903.htm (accessed July 30, 2014).

Share This




More Health & Medicine News

Wednesday, July 30, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Health Insurers' Profits Slide

Health Insurers' Profits Slide

Reuters - Business Video Online (July 30, 2014) Obamacare-related costs were said to be behind the profit plunge at Wellpoint and Humana, but Wellpoint sees the new exchanges boosting its earnings for the full year. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com
Concern Grows Over Worsening Ebola Crisis

Concern Grows Over Worsening Ebola Crisis

AFP (July 30, 2014) Pan-African airline ASKY has suspended all flights to and from the capitals of Liberia and Sierra Leone amid the worsening Ebola health crisis, which has so far caused 672 deaths in Guinea, Liberia and Sierra Leone. Duration: 00:43 Video provided by AFP
Powered by NewsLook.com
At Least 20 Chikungunya Cases in New Jersey

At Least 20 Chikungunya Cases in New Jersey

AP (July 30, 2014) At least 20 New Jersey residents have tested positive for chikungunya, a mosquito-borne virus that has spread through the Caribbean. (July 30) Video provided by AP
Powered by NewsLook.com
Generics Eat Into Pfizer's Sales

Generics Eat Into Pfizer's Sales

Reuters - Business Video Online (July 29, 2014) Pfizer, the world's largest drug maker, cut full-year revenue forecasts because generics could cut into sales of its anti-arthritis drug, Celebrex. Fred Katayama reports. Video provided by Reuters
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins