Identification of components of health complexity on internal medicine units by means of the INTERMED method.
BACKGROUND
The INTERMED was developed for the early identification of biological, psychological, social and health system factors considered interacting in health complexity. This is defined as the interference with the achievement of expected or desired health and service use outcomes when patients are exposed to standard care.


OBJECTIVE
The aim of this study was to test the INTERMED's ability to identify 'case' and 'care' complexity, identifying patients that would especially benefit from integrated care.


METHODS
Observational longitudinal study of Internal medicine in patients in two National Health System hospitals in Spain using the INTERMED (patients scoring ≥ 21 were considered to be 'complex'); the Cumulative Illness Rating Scale (CIRS), a severity of illness assessment; and standard clinical variables.


RESULTS
Six hundred and fifteen consecutives were included, and the prevalence of health complexity was 27.6%. The greatest differences between patients with and without health complexity were observed in the non-biological domains. Eighty-five per cent of patients with health complexity had non-biological items considered to require timely (immediately or soon) assistance or intervention compared to 30% of those without, nearly a threefold difference. Complex patients had a significantly higher number of medical diagnoses (p = 0.002) and number of psychiatric referrals (p = 0.041), but there were no differences in CIRS scores or lengths of stay.


CONCLUSIONS
The INTERMED has the potential to identify a considerable subset of complex internal medicine inpatients for which timely corrective action related to non-biological risk factors not typically uncovered during standard medical evaluations would be considered beneficial.
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
E
E
Lobo
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.|Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.|Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain.
T
T
Ventura
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.|Servicio de Psiquiatría, Hospital Doce de Octubre, Madrid, Spain.
M
M
Navio
Departamento de Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain.|Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
J
J
Santabárbara
Cartesian Solutions, Inc™, Burnsville, MN, USA.|Departments of Internal Medicine and Psychiatry, University of Minnesota, Minneapolis, MN, USA.
R
R
Kathol
Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain.|Hospital Residencia Profesor Rey Ardid, Zaragoza, Spain.
E
E
Samaniego
Servicio de Psiquiatría, Hospital Clínico Universitario, Zaragoza, Spain.
C
C
Marco
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain.|Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.|Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain.
A
A
Lobo
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013030:Spain