A scoping Review of tools used to assess patient Complexity in rheumatic disease

Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta

OBJECTIVES

This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada.

DESIGN

Qualitative exploration with relational conversations.

SETTING

Calgary, Alberta, Canada.

PARTICIPANTS

A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021.

RESULTS

Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors.

CONCLUSION

The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.

Key characteristics of patient complexity and patient complexity conceptual models/measurement tools: a scoping review protocol

INTRODUCTION

The social determinants of health have been gaining recognition, confirming that multidimensional biopsychosocial assessment is essential to improving the health of individuals. This trend has led to the development of conceptual models and measurement tools assessing 'patient complexity', understood as a complex interplay of biopsychosocial factors, to improve the efficiency and effectiveness of care; however, the variety of meanings encompassed by the term has led to confusion in the interpretation of patient complexity such that there is no consensus regarding the definition or conceptualisation of patient complexity. The primary objective of this scoping review is to identify and map what is known about the key characteristics of patient complexity through multiple database searches.

METHODS AND ANALYSIS

This study will follow an established framework for conducting scoping reviews. The data will be extracted through searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Library and Google Scholar. Included articles will have: investigated participants aged 19 years or older, with any health condition; described patient complexity, a model for patient complexity, or a measurement tool for patient complexity; and been published in English from 1 January 1970 to April 2022. Article selection and data extraction will be conducted independently by two reviewers and if necessary for consensus, a third reviewer. A descriptive summary will be prepared to explain how the results apply to the scoping review questions. The findings will be a detailed mapping of the health dimensions that emerge from the classification of the extracted data. Subsequently, a definition of patient complexity will be developed.

ETHICS AND DISSEMINATION

This review does not require ethical approval, as we will use publicly available data. The study findings will be disseminated through a relevant conference presentation and a peer-reviewed journal. This protocol is registered on the Open Science Framework (www.osf.io/hpa3c).

Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review

Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.

Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review

Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.

A scoping Review of tools used to assess patient Complexity in rheumatic disease

OBJECTIVE

Patients with rheumatic diseases often have multiple comorbidities which may impact well-being leading to high psychosocial complexity. This scoping review was undertaken to identify complexity measures/tools used in rheumatology that could help in planning and coordinating care.

METHODS

MEDLINE, EMBASE and CINAHL were searched from database inception to 14 December 2019 using keywords and Medical Subject Headings for "care coordination", "complexity" and selected rheumatic diseases and known complexity measures/tools. Articles describing the development or use of complexity measures/tools in patients with adult rheumatologic diagnoses were included regardless of study design. Included articles were evaluated for risk of bias where applicable.

RESULTS

The search yielded 407 articles, 37 underwent full-text review and 2 were identified during a hand search with 9 included articles. Only 2 complexity tools used in populations of adult patients with rheumatic disease were identified: the SLENQ and the INTERMED. The SLENQ is a 97-item patient needs questionnaire developed for patients with systemic lupus (n = 1 study describing tool development) and applied in 5 cross-sectional studies. Three studies (a practice article, trial and a cross-sectional study) applied the INTERMED, a clinical interview to ascertain complexity and support coordinated care, in patients with rheumatologic diagnoses.

CONCLUSIONS

There is limited information on the use of patient complexity measures/tools in rheumatology. Such tools could be applied to coordinate multidisciplinary care and improve patient experience and outcomes.

PATIENT CONTRIBUTION

This scoping review will be presented to patient research partners involved in co-designing a future study on patient complexity in rheumatic disease.