Richard W. Grant, MD, MPH; Clemens S. Hong, MD, MPH; Steven J. Atlas, MD, MPH
Richard W. Grant, MD, MPH
Kaiser Permanente Northern California
Oakland, CA 94612
Clemens S. Hong, MD, MPH
Steven J. Atlas, MD, MPH
Massachusetts General Hospital
Boston, MA 02114
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-0862.
Grant R., Hong C., Atlas S.; Defining Patient Complexity. Ann Intern Med. 2012;156:607. doi: 10.7326/0003-4819-156-8-201204170-00002
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Published: Ann Intern Med. 2012;156(8):607.
Dr. Olde Rikkert and colleagues address the challenge of identifying persons at high risk for negative health outcomes. Although we focused on complexity, they argue that frailty may represent another construct that physicians could use to identify such patients and cite a method by Rockwood and Mitnitski (1) that uses electronically available data, such as prescriptions and diagnoses, to assess cumulative frailty over time.
We agree that frailty is an important concept in the care of elderly patients that may have important implications for screening and treatment. Although there is undoubtedly some overlap between complexity and frailty, particularly among older persons, the concept of frailty is not likely to be as applicable to the many younger patients in our study (mean age, 50.9 years). We agree that future work should consider how complexity and frailty overlap, and validation of Rockwood and Mitnitski's method of measuring frailty is needed. Whether the construct of patient complexity or frailty is more useful in primary care management may be worthy of further investigation.
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