title: Identification of case complexity and increased health care utilization in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  To document biopsychosocial profiles of patients with rheumatoid arthritis (RA) by means of the INTERMED and to correlate the results with conventional methods of disease assessment and health care utilization.
  
  
  METHODS
  Patients with RA (n = 75) were evaluated with the INTERMED, an instrument for assessing case complexity and care needs. Based on their INTERMED scores, patients were compared with regard to severity of illness, functional status, and health care utilization.
  
  
  RESULTS
  In cluster analysis, a 2-cluster solution emerged, with about half of the patients characterized as complex. Complex patients scoring especially high in the psychosocial domain of the INTERMED were disabled significantly more often and took more psychotropic drugs. Although the 2 patient groups did not differ in severity of illness and functional status, complex patients rated their illness as more severe on subjective measures and on most items of the Medical Outcomes Study Short Form 36. Complex patients showed increased health care utilization despite a similar biologic profile.
  
  
  CONCLUSIONS
  The INTERMED identified complex patients with increased health care utilization, provided meaningful and comprehensive patient information, and proved to be easy to implement and advantageous compared with conventional methods of disease assessment. Intervention studies will have to demonstrate whether management strategies based on INTERMED profiles can improve treatment response and outcome of complex patients.
authors.affiliation: Psychiatry Service, University Hospital, Lausanne, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Koch
authors.forename: F
authors.initials: F
authors.lastname: Stiefel
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
authors.forename: J
authors.initials: J
authors.lastname: Fransen
authors.forename: A M
authors.initials: AM
authors.lastname: Chamot
authors.forename: J C
authors.initials: JC
authors.lastname: Gerster
authors.forename: F
authors.initials: F
authors.lastname: Huyse
authors.forename: A K
authors.initials: AK
authors.lastname: So
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000628:therapy*; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index