SAPCReN

Study Name: Defining patient complexity in primary care

Investigators: Stephanie Garies¹, Kerry McBrien¹, Divya Garg, Deidre Young, Emily Brockman², Halal Rashed²,

Affiliations:

1. Department of Family Medicine, University of Calgary
2. Primary Care Alberta

Status: recruiting primary care practices for focus groups

Abstract

Background: Understanding patient complexity is important – for clinicians to tailor care delivery, for practices to balance primary care team workloads, and for decision-makers for health system planning, reporting, and budgeting. However, there is no agreed-upon approach to measure patient complexity applicable to a primary care context. Most patient complexity scores are focused on multimorbidity which has only modest agreement with family physicians’ assessment of complexity. A comprehensive primary care patient complexity composite index, considering several domains (medical and mental health, acute care use, and social determinants) is needed.

Objectives:

1. To identify patient complexity indicators used in the primary care setting;
2. To assess the completeness and quality of primary care electronic medical record (EMR) data for development and operationalization of a complexity indicator.

Methods: This study employs a mixed-methods approach, including a scoping review to identify the complexity measures that currently exist for use in primary care. After selecting candidate measures for a complexity indicator, we will explore the completeness of EMR data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) and the Department of Family Medicine academic clinics. This will inform the operationalization of a composite complexity measure in domains such as medical complexity, social complexity, mental health issues, and healthcare utilization. Focus groups will be arranged with primary care practices to obtain their perspectives on defining patient complexity and feedback on how a complexity indicator could be developed and used within their context.