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Fact: Patients with complex past medical history are indeed complex
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When recently going through the October issue of Pediatrics, two articles caught my attention. (Question: is it me or half of the journal is about less-than-one-pound-babies?) The first one by Simon et al inks what we all have already witnessed: from 1997 to 2006, a) the proportion of patients hospitalized with complex chronic medical conditions increased from 8.9 to 10.1% , b) the absolute numbers went up, c) these patients accounted for ~40% of hospital charges. As their definition of complex chronic condition was rather shy, expect these numbers to be higher. Noteworthy, as the authors remind us, 20% of children eat 80% of the healthcare pie.
Merriam-Webster definition of complex #1: 'a group of obviously related units of which the degree and nature of the relationship is imperfectly known'. You can test this as follows. Get land. Build a big, square building. Equip it with hospital beds and hospital paraphernalia. Hire smart physicians and staff to meet the demands of the 21st century pediatric patient. Correct hydrocephalus, tracheomalacias, failure to thrive, short gut syndrome, intractable seizures or contractures (use plastic hardware at your discretion). Let it be rise with the local brew of nosocomial flora. Mix by folding gently. Wait 10-14 days before use.
Definition of complex #2: the sum of factors (as symptoms) characterizing a disease or condition. This leads to the other article in question, by Burns et al: the rate of hospitalization of patients with multiple complex chronic conditions –those affecting more than one organ/system—doubled.
How many of the last patients you saw were "complex"? I'd argue that complexity is/will be the norm rather than the exception. "Five year-old boy with past medical history significant for being non-significant". Establishing medical homes for these patients, as championed by the AAP, is crucial to address the multifaceted issues of their care. The other component I think it is to have clean, accurate and organized electronic medical records. I experienced that first-hand when my sister was once readmitted, and perhaps because she was complex everybody forgot to check a simple carbamazepine level.
So, arbitrarily, how much complexity defines complexity? I'd like to hear your comments and thoughts.