Who are our complex patients in the hospital, and how to identify them

Aims: Hospitals are looking for ways to improve care for complex patients. A solution for improvement is to add a case manager to a team to coordinate the care for these patients. But who are these complex patients and how do we define them? In two large academic hospitals, we examined whether the Intermed Self-assassment questionnaire can detect complex patients and can therefore be a tool to identify patients who benefit from case management in the hospital. Methods: A cross sectional prevalence survey in two academic hospitals. The study population were inpatients in all clinical departments (admitted ≥24 hour). Excluded were patients admitted on the 1CU, CCU and ER. We collected data from the electronic medical record and completed questionnaires together with the patient at one random day in 2017 and 2018. Descriptive statistics and chi-squared tests were performed with SPSS version 24.0. Results: The study in 2017 in one academic hospital (N=241/114) showed that 22% of the patients can be defined as 'complex', i.e. a score of 19 or higher on the IMSA. 20% of admitted patients experienced long lasting psychiatric problems in the past, and 11% reported psychiatric problems during admission. Although 'only' 3% reported no social support at all, 21% of the patients reported support but not at all time or immediately available. 25% reported negative experiences in the past with health care workers, and 33% expects to be in need for more health care support in the near future. A (non)significant relation was found between a high IMSA score and prevalence of decubitus and re-admission. Data and results of the study in two academic hospitals, performed in 2018, will be presented at the EAPM conference. Conclusion: A first cautious conclusion is that the percentage of complex patients found with the IMSA corresponds with results from previous studies. The IMSA is suitable to identify complex patients and provide additional information about the areas of complexity. Therefore, the IMSA can be used as an efficient tool to determine for which patients case management is useful.