COMPLEXiometer

leftpanel

to measure the complexity of a patient case

Created by Peter Loewen, Patricia Gerber, Boris Trinjastic,

Stacey Tkachuk, Asal Taheri, George Pachev, Sue Corrigan

based on INTERMED and MRCI | peter.loewen@ubc.ca

CaseID:

Biologic

score:

Chronicity

0 - Less than 3 months of physical dysfunction 1 - More than 3 months of physical dysfunction or several periods of less than 3 months 2 - A chronic disease 3 - Several chronic diseases

Diagnostic Dilemma

0 - No periods of diagnostic complexity 1 - Diagnosis and etiology was clarified quickly 2 - Diagnostic dilemma solved but only with considerable diagnostic effort 3 - Diagnostic dilemma not solved despite considerable diagnostic efforts

Symptoms Severity/Impairment

0 - No symptoms or symptoms reversible without intensive medical efforts 1 - Mild but notable symptoms, which do not interfere with current functioning 2 - Moderate to severe symptoms, which interfere with current functioning 3 - Severe symptoms leading to inability to perform any functional activities

Diagnostic/Therapeutic Challenge

0 - Clear diagnoses and/or uncomplicated treatment 1 - Clear differential diagnoses and/or diagnosis expected with clear treatments 2 - Difficult to diagnose and treat, physical cause/origin and treatment expected 3 - Difficult to diagnose or treat, other issues than physical causes interfering with the diagnostic and/or therapeutic process

Complications and Life Threat

0 - Unknown, or No risk of limitations in activities of daily living 1 - Mild risk of limitations in activities of daily living 2 - Moderate risk of permanent and/or substantial limitations of activities in daily living 3 - Severe risk of physical complications with serious permanent functional deficits and/or dying

Psychologic

score:

Barriers to Coping

0 - Ability to manage stress, such as through support seeking or hobbies 1 - Restricted coping skills, such as need of control, illness denial, or irritability 2 - Impaired coping skills, such as non-productive complaining or substance abuse but without serious impact on medical condition, mental health, or social situation 3 - Minimal coping skills, manifest by destructive behaviors, such as substance dependence, psychiatric illness, self-mutilation, or attempted suicide

Psychiatric Dysfunction

0 - No psychiatric dysfunction 1 - Psychiatric dysfunction without clear effects on daily function 2 - Psychiatric dysfunction with clear effects on daily function 3 - Psychiatric admission(s) and/or permanent effects on daily function

Resistance to Treatment

0 - Interested in receiving treatment and willing to cooperate actively 1 - Some ambivalence though willing to cooperate with treatment 2 - Considerable resistance, such as non-adherence with hostility or indifference towards health care professionals and/or treatment 3 - Active resistance to medical care

Psychiatric Symptoms

0 - No psychiatric symptoms 1 - Mild psychiatric symptoms, such as problems with concentration or feeling tense 2 - Moderate psychiatric symptoms, such as anxiety, depression or mild cognitive impairment 3 - Severe psychiatric symptoms and/or behavioral disturbances, such as violence, self-inflicted harm, delirium, psychosis, or mania

Mental Health Threat

0 - No risk of psychiatric disorder 1 - Mild risk of psychiatric symptoms, such as stress, anxiety, feeling blue, substance abuse or cognitive disturbance; mild risk of treatment resistance (ambivalence) 2 - Moderate risk of psychiatric disorder requiring psychiatric care; moderate risk of treatment resistance 3 - Severe risk of psychiatric disorder requiring frequent ER-visits and/or hospital admissions; risk of refusal of treatment for serious psychiatric disorder

Social

score:

Job and Leisure Problems

0 - A job (including housekeeping, retirement, studying) and having leisure activities 1 - A job (including housekeeping, retirement, studying) without leisure activities 2 - Unemployed now and for at least 6 month with leisure activities 3 - Unemployed now and for at least 6 month without leisure activities

Social Dysfunction

0 - No social disruption 1 - Mild social dysfunction; interpersonal problems 2 - Moderate social dysfunction, such as inability to initiate or maintain social relations 3 - Severe social dysfunction, such as involvement in disruptive social relations or social isolation

Residential Instability

0 - Stable housing; fully capable of independent living 1 - Stable housing with support of others, e.g. family, home care, or an institutional setting 2 - Unstable housing, e.g. no support at home or living in a shelter; change of current living situation is required 3 - No current satisfactory housing, e.g. transient housing or dangerous environment; immediate change is necessary

Poor Social Support

0 - Assistance readily available from family, friends, and/or acquaintances, such as work colleagues, at all times 1 - Assistance available from family, friends, and/or acquaintances, such as work colleagues, but possible delays 2 - Limited assistance readily available from family, friends, and/or acquaintances, such as work colleagues 3 - No assistance readily available from family, friends, and/or acquaintances, such as work colleagues, at all times

Social Vulnerability

0 - No risk of changes in the living situation; adequate social support and integration 1 - No risk of changes in the living situation but additional social support and/or increased integration is needed, e.g. home health care 2 - Risk of need for temporary or permanent admission to facility/institution in the foreseeable future 3 - Risk of need for temporary or permanent admission to facility/institution now

Health System

score:

Access to Care

0 - Adequate access to care 1 - Some limitation in access to care due to insurance problems, geographical reasons, language, or cultural barriers 2 - Difficulties in access to care due to insurance problems, geographical reasons, language, or cultural barriers 3 - No adequate access to care due to insurance problems, geographical reasons, language, or cultural barriers

Treatment Experience

0 - No problems with healthcare professionals 1 - Negative experience with healthcare professionals (self or relatives) 2 - Requests for second opinions or changing doctors more than once; multiple providers; trouble keeping consistent and/or preferred provider(s) 3 - Repeated conflicts with doctors, frequent ER-visits, or involuntary admissions; forced to stay with undesirable provider due to cost, provider network options, or other reasons

Organization of Care

0 - Primary care/General practitioner only 1 - Specialist services either in the general health care or mental health/SUD care 2 - Both general health care and MH/SUD care services 3 - Hospitalization or transfer from a hospital of patients, who qualify in ambulatory care on Level 2

Coordination of Care

0 - Complete practitioner communication and good coordination of care 1 - Limited practitioner communication and coordination of care; primary care physician coordinates medical and MH/SUD services 2 - Poor communication and coordination of care among practitioners; no routine primary care physician 3 - No communication and coordination of care among practitioners; primary ER use to meet non-emergent health needs

Health System Impediments

0 - No risk of impediments to coordinated physical and MH/SUD care 1 - Mild risk of impediments to care, e.g. insurance restrictions, distant service access, limited provider communication and/or care coordination 2 - Moderate risk of impediments to care, e.g. potential insurance loss, inconsistent practitioners, communication barriers 3 - Severe risk of impediments to care, e.g. little or no insurance, resistance to communication and coordination among providers

Medication Regimen

score:

Number of Medications

including regimens used only periodically,. e.g. for migraine, gout, COPD exacerbation, etc.

0 - No regularly scheduled medications 1 - 1-2 regularly scheduled medications 2 - 3-5 regularly scheduled medications 3 - >5 regularly scheduled medications

Medication Route

0 - All medications taken orally as a tablet or capsule. 1 - Any regularly scheduled medication is an oral mouthwash, gum/lozenge, liquid, sublingual, topical paint/solution, patch, nasal spray, enema 2 - Any regularly scheduled medication is a dressing, paste, ear/eye/nasal drop/cream/ointment, inhaler (accuhaler/aerosilizer/turbuhaler/diskhaler), injectable from pre-filled syringe, pessary 3 - Any regularly scheduled medication is a metered-dose inhaler, nebuliser, dialysate, injectable from an ampuoule

Medication Frequency & Directions

0 - no medications, or all medications taken once or twice daily, no PRNs, AND no medications use alternate daily dosing, tapering, or "take as directed" 1 - all medications taken once or twice daily (including PRNs taken less than 4 times daily) OR any medication requires breaking/crushing, dissolving, being taken in specific relation to food, at a specific time of day, with a specific fluid for administration 2 - any medication taken more than twice daily (including PRNs used more than 3x daily) OR any medication uses alternate daily dosing, tapering, or "take as directed" 3 - any medication taken more than twice daily (including PRNs used more than 3x daily) AND any medication uses alternate daily dosing, tapering, or "take as directed"