title: Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity.
abstract: BACKGROUND
  Complexity in medicine needs to be reduced to simple components in a way that is comprehensible to researchers and clinicians. Few studies in the current literature propose a measurement model that addresses both task and patient complexity in medicine.
  
  
  OBJECTIVE
  The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The measurement model was adapted and modified for the healthcare domain.
  
  
  METHODS
  Three clinical infectious disease teams were observed, audio-recorded and transcribed. Each team included an infectious diseases expert, one infectious diseases fellow, one physician assistant and one pharmacy resident fellow. The transcripts were parsed and the authors independently coded complexity attributes. This baseline measurement model of clinical complexity was modified in an initial set of coding processes and further validated in a consensus-based iterative process that included several meetings and email discussions by three clinical experts from diverse backgrounds from the Department of Biomedical Informatics at the University of Utah. Inter-rater reliability was calculated using Cohen's kappa.
  
  
  RESULTS
  The proposed clinical complexity model consists of two separate components. The first is a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions. The second is the patient complexity model with 11 complexity-contributing factors and 5 dimensions.
  
  
  CONCLUSIONS
  The measurement model for complexity encompassing both task and patient complexity will be a valuable resource for future researchers and industry to measure and understand complexity in healthcare.
authors.affiliation: Roosan Islam, PharmD, University of Utah, Department of Biomedical Informatics, 421 Wakara Way, Ste 140, Salt Lake City, UT 84108-3514, USA, E-mail: roosan.islam@utah.edu.
authors.forename: R
authors.initials: R
authors.lastname: Islam
authors.forename: C
authors.initials: C
authors.lastname: Weir
authors.forename: G
authors.initials: G
authors.lastname: Del Fiol
mesh_terms: D003141:Communicable Diseases / Q000628:therapy; D020000:Decision Support Systems, Clinical; D006801:Humans; D055552:Infectious Disease Medicine / Q000379:methods*; D008490:Medical Informatics / Q000379:methods; D008962:Models, Theoretical; D015588:Observer Variation; D010595:Pharmacists; D010823:Physician Assistants; D010820:Physicians; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012984:Software
keywords: Clinical/Utilization; Decision Complexity; Decision Support Systems; Health Care/methods; Humans; Information Technology; Quality Assurance; Social Medicine/Methods; Software Design