Patient complexity: More than comorbidity. The Vector Model of Complexity
Patient complexity: More than comorbidity. The Vector Model of Complexity
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DOI：
10.1007/s11606-007-0307-0
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发表时间：
2007-12-01
影响因子：
5.7
通讯作者：
Kiefe, Catarina I.
中科院分区：
文献类型：
--
作者：
Safford, Monika M.;Allison, Jeroan J.;Kiefe, Catarina I.
背景：患者复杂性的概念化在临床医学中才刚刚起步。
目的：本研究旨在（1）提出一种针对复杂患者的概念性方法；（2）展示这种方法如何促进患者与医疗服务提供者之间达成一致，这是制定最有效治疗方案的关键步骤；（3）检验用于指导权衡决策以及评估复杂患者医疗质量的证据的可用性。
方法/结果：复杂性向量模型将生物、社会经济、文化、环境和行为等因素之间的相互作用描述为健康的决定因素。这些因素不易辨别，但对慢性疾病的治疗过程和结果有着深远影响。实现患者、医生和医疗系统之间的一致对于有效的以患者为中心的医疗至关重要；需要对向量模型的所有轴进行评估；并且通常需要做出权衡决策以制定量身定制的治疗方案。大多数基于证据的指南很少为权衡决策提供指导。质量衡量指标往往将复杂患者排除在外，且并非明确为评估他们的整体医疗保健而设计。
结论/建议：我们迫切需要扩大证据基础，以便为各类复杂患者的医疗提供信息，特别是对于量身定制医疗至关重要的临床权衡决策。我们提供长期和短期策略，以便在向量模型的指导下，开始将复杂性纳入质量衡量和绩效分析。跨学科研究应为更深入理解患者复杂性的多种来源及其相互作用，以及医疗保健的提供应如何与复杂性相协调以优化健康奠定基础。
BACKGROUND: The conceptualization of patient complexity is just beginning in clinical medicine.OBJECTIVES: This study aims (1) to propose a conceptual approach to complex patients; (2) to demonstrate how this approach promotes achieving congruence between patient and provider, a critical step in the development of maximally effective treatment plans; and (3) to examine availability of evidence to guide trade-off decisions and assess healthcare quality for complex patients.METHODS/RESULTS: The Vector Model of Complexity portrays interactions between biological, socioeconomic, cultural, environmental and behavioral forces as health determinants. These forces are not easily discerned but exert profound influences on processes and outcomes of care for chronic medical conditions. Achieving congruence between patient, physician, and healthcare system is essential for effective, patient-centered care; requires assessment of all axes of the Vector Model; and, frequently, requires trade-off decisions to develop a tailored treatment plan. Most evidence-based guidelines rarely provide guidance for trade-off decisions. Quality measures often exclude complex patients and are not designed explicitly to assess their overall healthcare.CONCLUSIONS/RECOMMENDATIONS: We urgently need to expand the evidence base to inform the care of complex patients of all kinds, especially for the clinical trade-off decisions that are central to tailoring care. We offer long- and short-term strategies to begin to incorporate complexity into quality measurement and performance profiling, guided by the Vector Model. Interdisciplinary research should lay the foundation for a deeper understanding of the multiple sources of patient complexity and their interactions, and how provision of healthcare should be harmonized with complexity to optimize health.