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


METHODS
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.


CONCLUSIONS
With its components largely supported by existing literature, the model has implications for analytic design, clinical epidemiology, and clinical practice.
Division of Health Care Policy & Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. shippee.nathan@mayo.edu
Nathan D
ND
Shippee
Nilay D
ND
Shah
Carl R
CR
May
Frances S
FS
Mair
Victor M
VM
Montori
D002908:Chronic Disease / Q000628:therapy*; D015897:Comorbidity; D017281:Cost of Illness; D057220:Health Literacy; D006297:Health Services Accessibility; D006801:Humans; D008962:Models, Theoretical; D017711:Nonlinear Dynamics; D010349:Patient Compliance; D018802:Patient-Centered Care; D012648:Self Care; D012959:Socioeconomic Factors; D016526:Workload