Open Access
Methods Inf Med 2016; 55(01): 14-22
DOI: 10.3414/ME15-01-0031
Original Articles
Schattauer GmbH

Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity

R. Islam
1   University of Utah, Biomedical Informatics, School of Medicine, Salt Lake City, Utah, USA
,
C. Weir
1   University of Utah, Biomedical Informatics, School of Medicine, Salt Lake City, Utah, USA
,
G. Del Fiol
2   University of Utah, Biomedical Informatics, Salt Lake City, Utah, USA
› Author Affiliations
Further Information

Correspondence to:

Roosan Islam, PharmD
University of Utah
Department of Biomedical Informatics
421 Wakara Way, Ste 140
Salt Lake City, UT 84108-3514
USA

Publication History

Received 01 March 2015

Accepted 25 June 2015

Publication Date:
08 January 2018 (online)

 

Summary

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. Conclusion: 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.


 



Correspondence to:

Roosan Islam, PharmD
University of Utah
Department of Biomedical Informatics
421 Wakara Way, Ste 140
Salt Lake City, UT 84108-3514
USA