Barbara J. Turner, MD, MSEd, MA; Leona Cuttler, MD
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-2615.
Requests for Single Reprints: Barbara J. Turner, MD, MSEd, MA, 7411 John Smith Road, Suite 1050, San Antonio, TX 78229; e-mail, email@example.com.
Current Author Addresses: Dr. Turner: 7411 John Smith Road, Suite 1050, San Antonio, TX 78229.
Dr. Cuttler: The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, 11100 Euclid Avenue, Suite 737, Mailstop RB&C 6004, Cleveland, OH 44106.
Turner BJ, Cuttler L. The Complexity of Measuring Clinical Complexity. Ann Intern Med. 2011;155:851-852. doi: 10.7326/0003-4819-155-12-201112200-00009
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Published: Ann Intern Med. 2011;155(12):851-852.
Measuring patient complexity in the ambulatory care setting has significant implications for patients, physicians, insurers, and policymakers and, consequently, is the subject of vigorous debate. The increasing prevalence of chronic diseases and multiple comorbid conditions in both adults and children (1-2) is producing many more patients with complex clinical needs. Managing these patients requires greater clinician effort, increased health care and non–health care resources, and substantial caregiver and community support. Unless the demanding care of complex patients is appropriately considered and compensated, clinicians have a powerful incentive to select healthier patients and to spurn those who are more difficult to manage. Because of this concern, an expert panel recommended offering financial incentives for the care of clinically complex patients (3). Measures that account for clinical complexity are also necessary in the coming era of pay-for-performance, because standard quality measures are often developed in study populations that exclude complex patients. Applying inappropriate quality measures to complex patients can distract clinicians from addressing these patients' unmet, higher-priority needs and unique aspects of care (4). Thus, measuring clinical complexity has important implications for the everyday practice of medicine.
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