The complexity score: towards a clinically-relevant, clinician-friendly measure of patient multi-morbidity
Bibliographic record
Abstract
Rationale and Objectives: The population is rapidly aging and concurrent chronic diseases are increasing rapidly in the developed world. Health systems, clinicians, patients and care givers are challenged by the provision of care in this complex environment. Clinical assessment tools are needed to optimize management and facilitate informed decision-making by patients and care givers. We propose and evaluate a simple tool called the complexity score and evaluate its properties in terms of its distribution in a senior population in an academic family practice and assess its association with health services utilization.Methods: We performed a retrospective chart audit of 2,450 patients aged 65 and older seen in an academic family practice in Ontario, Canada. We calculated the complexity score for each patient and analyzed the scores by age and gender. Using logistic and Poisson regression we evaluated the association of age, gender, marital status and complexity score with hospital admission (surgical and medical), emergency room visits and family practice visits.Results: The complexity score of the practice was high. Overall median complexity score increased with age (65-69: 12, 85+: 16). Age, gender and complexity score were independently and statistically significantly associated with increased hospitalizations, emergency room visits and family physician visits. The OR for the complexity score was substantially increased for the highest complexity score in comparison to the reference group: OR ER visit: 6.5 (95% CI: 3.798-11.058), OR Hospitalization:12.08 (95% CI: 6.404-22.79). Age alone at most doubled the OR for these associations.Conclusions: Multi-morbidity is common amongst older adults in an academic family practice. The complexity score is a simple to calculate measure that has the capacity to inform clinicians and patients on anticipated health service utilization. Further prospective studies are required to replicate the strong and significant associations described in this study. Further measurement tools that capture patient wellbeing and functional status are required to compliment this measure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".