Open AccessThe complexity of patients hospitalized in Internal Medicine wards evaluated by FADOI-COMPLIMED score(s). A hypothetical approach
Author(s) -
Erminio Bonizzoni,
Gualberto Gussoni,
Giancarlo Agnelli,
Raffaele Antonelli Incalzi,
Moira Bonfanti,
Franco Mastroianni,
Marco Candela,
Carlotta Franchi,
Stefania Frasson,
Antonio Greco,
Micaela La Regina,
Roberta Re,
Giorgio Vescovo,
Mauro Campanini
Publication year - 2018
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0195805
Subject(s) - medicine , mews , comorbidity , logistic regression , cohort , depression (economics) , physical therapy , barthel index , activities of daily living , early warning score , emergency medicine , economics , macroeconomics
Objectives The aim of this study is to develop a new predictive model to measure complexity of patients in medical wards. Setting 29 Internal Medicine departments in Italy. Materials and methods The study cohort was made of 541 consecutive patients hospitalized for any cause, aged more than 40 years and with at least two chronic diseases. First, we applied a hierarchical cluster analysis and the principal component analysis (PCA) to a panel of questionnaires [comorbidity (Charlson, CIRS), clinical stability (MEWS), social frailty (Flugelman), cognitive dysfunction (SPSMQ), depression (5-item GDS), functional dependence (ADL, IADL, Barthel), risk of sore threats (Exton-Smith scale), nutrition (MNA), pain (NRPS), adherence to therapy (Morisky scale)], in order to select domains informative for the definition of complexity. The following step was to create the score(s) needed to quantify it. Results Two main clusters were identified: the first includes 7 questionnaires whose common denominator is dependence and frailty, the second consists of 3 questionnaires representative of comorbidity. Globally, they account for about 70% of the total variance (55.2% and 13.8%, respectively). The first principal component was simplified in “Complimed Score 1” (CS1) as a recalibrated average between the Barthel Index and the Exton Smith score, whereas the second cluster was approximated to “Complimed Score 2” (CS2), by using the Charlson score only. Conclusions Complexity is a two-dimensional clinical phenomenon. The FADOI-Complimed Score(s) is a new tool useful for the routine evaluation of complexity in medical patients, simple to use and taking around 10 minutes to complete.