Introduction
Context
Measuring and Assessing Biopsychosocial Complexity: The Questionnaire Approach
Measuring and Assessing Biopsychosocial Complexity: A Multi-sourced Data Analytics Approach
Methods
Results
VCAT-CM Conceptual Domains
Domain | Definition |
---|---|
Q1: Attachment | Clients unattached or poorly attached despite need for primary care |
Q2: Service density | Clients attached to primary care providers but experiencing a period of functional instability that are challenging to manage within a Fee for Service (FFS) practice. These clients use multiple (and poorly coordinated) health and social care program area services, coupled with access challenges (manifested by no-shows). Intent of CHC engagement would be to stabilize the client, rationalize services, and support eventual transition back to community (FFS) primary care provider where possible |
Q3: Social and environmental factors | Clients with multiple social barriers such as housing instability, poverty etc. that impact on the ability to maintain a connection to care |
Q4: Psychosocial factors | Clients with marked difficulties in accessing the fee-for-service health care system due to significant cognitive, behavioral and/or functional impairment |
Q5: Relationships | Inability to maintain lasting personal or professional relationships |
Q6: Activities of daily living (ADLs) | Clients with marked difficulties with activities of daily living without access to appropriate supports |
Q7: Medical complexity | Medically complex conditions presenting with chronic disease, concurrent disorders or communicable diseases (i.e. diabetes, hepatitis, HIV, mental health issues, substance misuse) that are untreated or uncontrolled |
Q8: Acute (hospital) utilization | High emergency department use for issues that could be addressed in the primary care setting and/or frequent acute care admission/readmission rates |
Q9: Risk of harm to self or others | Risk of causing harm to self or others |
Complexity Calculation
Domain | Data sources and elements | Rationale (selection of data sources and elements) | Q-scoring system | Rationale (Q-scoring system) |
---|---|---|---|---|
Q1 |
IntraHealth Profile EMR
Encounters
PARIS EMR
Encounters | Very reliable information and readily available. In accordance with definitions of attachment/un-attachment from a variety of sources (i.e. British Columbia Ministry of Health (MoH), DTES 2nd generation services [a new model of care that will give residents of the DTES better access to coordinated, consistent health care; it brings together existing programs and services so clients get the care they need at one location], Primary Care) | Score = 0: clients with 4 + visits in past 18 months (equally dispersed) Score = 1: clients with 3 visits in past 18 months Score = 2 : clients with 2 visits in past 18 months Score = 3 : clients with 1 visit in past 18 months Score = 4 : clients with no visits in past 18 months | Included in the calculation were the clients who had at least 1 encounter in the past 18 months. Encounters equally dispersed over the period of 18 months were considered (i.e. encounters which were less than a week apart were collapsed into a single encounter). The higher the number of encounters, the lower the attachment score |
Q2 |
IntraHealth Profile EMR
Encounters
PARIS EMR
Encounters Referrals to services | Very reliable information and readily available. In accordance with definitions of attachment/un-attachment from a variety of sources (MoH, DTES 2nd generation services, Primary Care) | Score = 0 : clients seen in one service/program Score = 1 : clients seen in two services/programs Score = 2: clients seen in three services/programs Score = 3: clients seen in four services/programs Score = 4: clients seen in more than four services/programs If # of NSBA (no show with booked appointment) in past 18 months > 10 elevate score by 1 | The higher the number of simultaneously open referrals a client has, the higher the complexity score. If the client has 10 + no shows with booked appointment in the past 18 months the complexity score is elevated by 1 |
Q3 |
PARIS EMR
Latest HoNOS Assessment: question 11 for Housing instability and Question 12 for problems with occupation and activities
IntraHealth Profile EMR
Persons With Disabilities (PWD) forms Social History (SHX) codes | Validity of the HoNOS assessment and its sensitivity to small changes in scores | Score = 0: a score of 0 for HoNOS Question 11 or 12 Score = 1: a score of 1 for HoNOS Question 11 or 12 Score = 2: a score of 2 for HoNOS Question 11 or 12 Score = 3: a score of 3 for HoNOS Question 11 or 12 Score = 4: a score of 4 for HoNOS Question 11 or 12 AND/OR the client has PWD forms AND/OR SHX problems recorded | The higher the score on the HoNOS question, the higher the complexity score. If PWD form present and social history codes present the score is elevated |
Q4 |
PARISProfile EMR
Latest HoNOS Assessment (Q4 for cognitive, Q1 and Q8 for behavioral, Q5 for functional impairment) | Validity of the HoNOS assessment and its sensitivity to small changes in scores | Score = 0: a score of 0 for HoNOS Question 1 AND/OR Question 4 AND/OR Question 5 AND/OR Question 8 Score = 1: a score of 1 for HoNOS Question 1 AND/OR Question 4 AND/OR Question 5 AND/OR Question 8 Score = 2: a score of 2 for HoNOS Question 1 AND/OR Question 4 AND/OR Question 5 AND/OR Question 8 Score = 3: a score of 3 for HoNOS Question 1 AND/OR Question 4 AND/OR Question 5 AND/OR Question 8 Score = 4: a score of 4 for HoNOS Question 1 AND/OR Question 4 AND/OR Question 5 AND/OR Question 8 | The higher the score on the HoNOS question, the higher the complexity score |
Q5 |
PARIS EMR
Latest HoNOS Assessment (Q9, Q11 and Q12)
IntraHealth Profile EMR
SHX codes | Validity of the HoNOS assessment and its sensitivity to small changes in scores | Score = 0: a score of 0 for HoNOS Question 9 AND/OR HoNOS Question 11 AND/OR Question 12 Score = 1: a score of 1 for HoNOS Question 9 AND/OR HoNOS Question 11 AND/OR Question 12 Score = 2: a score of 2 for HoNOS Question 9 AND/OR HoNOS Question 11 AND/OR Question 12 Score = 3: a score of 3 for HoNOS Question 9 AND/OR HoNOS Question 11 AND/OR Question 12 Score = 4: a score of 4 for HoNOS Question 9 AND/OR HoNOS Question 11 AND/OR Question 12 AND/OR the client has SHX problems recorded | The higher the score on the HoNOS question, the higher the complexity score. If social history codes present then the score is elevated |
Q6 |
PARIS EMR
InterRAI-MDS assessment in Home Health (MAPLE scores, CAPS) Occupational Therapy (OT)/Physiotherapy (PT) assessments for mobility Latest HoNOS Assessment (Q5 for physical illness and disability, Q10 for activities of daily living, Q11 for housing and Q12 for occupation and activities) | Validity of the HoNOS assessment and its sensitivity to small changes in scores, validity of InterRAI tool | Score = 0: a score of 0 for HoNOS Question 5 AND/OR Question 10 AND/OR Question 11 AND/OR Question 12 Score = 1: a score of 1 for HoNOS Question 5 AND/OR Question 10 AND/OR Question 11 AND/OR Question 12 Score = 2: a score of 2 for HoNOS Question 5 AND/OR Question 10 AND/OR Question 11 AND/OR Question 12 Score = 3: a score of 3 for HoNOS Question 5 AND/OR Question 10 AND/OR Question 11 AND/OR Question 12 Score = 4: a score of 4 for HoNOS Question 5 AND/OR Question 10 AND/OR Question 11 AND/OR Question 12 AND/OR INTERRAI-MDS Ax AND/OR Transfer/Bed Mobility Ax (PARIS) | The higher the score on the HoNOS question, the higher the complexity score. If InterRAI-MDS assessment and/or OT/PT assessments for mobility present then the score is elevated |
Q7 |
IntraHealth Profile EMR
Problem List Medications (EMR) PSW forms SHX codes
PARIS EMR
Latest HoNOS Assessment (Q6, Q7, Q8 for mental health issues, Q3 for substance misuse) | Validity of the HoNOS assessment and its sensitivity to small changes in scores | Score = 0: no diagnosis recorded in the problem list Score = 1: 4 + diagnoses recorded in the problem list Score = 2: any SU/MH diagnosis recorded in the problem list AND client not on Extended Leave Score = 3: 2 + diagnoses recorded in the problem list AND any SU/MH diagnosis (Schizophrenia) Score = 4: Complex Care Diagnostic Codes (according to General Practice Services Committee—GPSC, Jan 2018) OR 6 + diagnoses recorded in the problem list OR (any SU/MH diagnosis AND client on Extended Leave) Or a Chronic Neurodegenerative Disorder or a score of 4 on any question in the last HoNOS assessment If more than 5 dx elevate score by 1 If BP > 140/90 elevate score by 0.5 If BMI > 25 elevate score by 0.25 If BMI > 30 elevate score by 0.5 If BMI > 35 elevate score by 0.75 | The higher the number of chronic conditions, the higher the score. If MHSU conditions present the score is elevated. If there exist combinations of chronic conditions (according to GPSC) the score is elevated even more. If BMI > 25 or BP > 140/90 score is again elevated |
Q8 |
EDMart and AcuteMart
ED visits by CTAS LOS (acute admissions) | Accurate information, face validity, availability of data | Score = 0: Hospitalization Complexity Score of 0 Score = 1: Hospitalization Complexity Score between 1 and 24 Score = 2: Hospitalization Complexity Score between 15 and 25 Score = 3: Hospitalization Complexity Score between 25 and 50 Score = 4: Hospitalization Complexity Score > 50 | Calculation based on inverse CTAS score and Length of Stay in hospital. The higher the combined score, the higher the complexity score |
Q9 |
IntraHealth Profile EMR
Alerts (violence) PHQ Extended leave
PARIS EMR
Extended Leave Alerts (violence) HoNOS Assessment (Q1 and Q2) | Validity of the HoNOS assessment and its sensitivity to small changes in scores | Score = 0: a score of 0 for HoNOS Question 1 AND/OR HoNOS Question 2 Score = 1: a score of 1 for HoNOS Question 1 AND/OR HoNOS Question 2 Score = 2: a score of 2 for HoNOS Question 1 AND/OR HoNOS Question 2 Score = 3: a score of 3 for HoNOS Question 1 AND/OR HoNOS Question 2 Score = 4: a score of 4 for HoNOS Question 1 AND/OR HoNOS Question 2 AND/OR the client has violence alerts recorded AND/OR client is on Extended Leave AND/OR client has a score greater than 9 on the latest PHQ9 | The higher the score on the HoNOS question, the higher the complexity score. If violence alerts present or client on extended leave, the score was elevated |