Background:
Care of complex patients are a daily challenge in the hospital setting, with a direct impact on the health care costs. Although there is no standard definition of a “complex” patient, we can argue that they are patients who need more time and resources during their care process. Age and comorbidities are probably important factors contributing to the patient complexity, but little is known about the characteristics of complex patients, in particularly in the hospital setting. Therefore, we aim to identify the characteristics of patient’s complexity in the hospital setting.
Methods:
We conducted a cross-sectional study in which we surveyed the physicians from the medical wards of 3 large Swiss hospitals between July and October 2015. All physicians involved in patient care (residents, attending, faculties) were invited to participate to the survey via Email, with a reminder 2 weeks later. All physicians working in each medical ward were eligible to participate only once, and the survey was anonymous. The survey instrument was developed based on a literature review, and clinical experience. The survey contained 21 close-ended questions on characteristics that might influence patient complexity with answer on a scale from 1 (no influence) to 4 (great influence). The questions were grouped into 6 categories of characteristics: provider demographics, patient characteristics, patient diagnoses and comorbidities, treatment care, hospital structure and process, communication.
Results:
Among the 111 responders (response rate 53%), 55.5% (n=61) were female, 65.5% (n=72) were resident, 25.5% (n=28) attending, and 9% (n=10) faculty. The median number of years since MD was 5 (IQR 3-7). Comorbidity was the most overall frequently rated characteristics that was considered to influence patient complexity, with 95% (n=106) of the responders rating this characteristics as having either a moderate (26%, n= 29), or a high (69%, n=77) influence on patient complexity. The 9 other most frequently characteristics rated as high influence were the number of medication changes (47%, n=52), a psychiatric disease (46%, n=51), difficulties in the communication with the patient (46%, n=51), aggressiveness (47%, n=52), drug or alcohol abuse (41%, n=46), interdisciplinary communication (45%, n=50), number of drug prescription (41%, n=46), coordination of care (43%, n=47). On the other hand, patient characteristics such as gender (1%, n=1), social support (4%, n=4), living alone (2%, n=2), or patient education (9%, n=10), were not rated as having a high influence on patient complexity. Between the 6 categories of characteristics, patient diagnoses and comorbidities was rated as the most important factors. The reported mean proportion of complex patients was equally distributed between 20 and 80%.
Conclusions:
Most important factors identified as influence the patient complexity in the hospital setting were patient comorbidities, in particularly psychiatric disease, communication difficulties (with the patient, and also interdisciplinary), number and changes of medication, drug or alcohol abuse, and coordination, and patient aggressiveness and limited mobility. The proportion of complex patients reported ranged widely, between 20 and 80%, and may suggest interpersonal differences in considering the threshold of patient complexity.