Measuring Case Complexity on a Specialist Geriatric Subacute Frailty ward: A feasibility study of the INTERMED Self-Assessment questionnaire (IMSA)
Bibliographic record
Abstract
Abstract Background The IMSA questionnaire is a validated tool which assesses the biopsychosocial complexity of patients across four domains (physical, mental, social, and healthcare). However, the self-assessment format is not always suitable for individuals with cognitive impairment. We aim to evaluate the feasibility of performing a modified IMSA score combining self-assessment and chart review on a frailty rehabilitation ward. Methods We carried out a pilot study with the IMSA (V1.0) questionnaire, utilising a combination of chart review and self-assessment questionnaires. Questionnaires were administered by various members of the multidisciplinary team. Descriptive statistics and Pearson’s correlation were used for our analysis. Results Self-assessment via questionnaire was performed with 15 patients. 5 patients were noted to have difficulty with self-reporting so chart review was used to supplement information on these patients. The assessment took a median time of 20 mins to complete (12-29). The median age in our cohort (n=15) was 87 (67-97), 12 of 15 were female (80%). The median IMSA score was 26 (15-43), with 80% of patients scoring ≥ 20 (indicating a high complexity). IMSA score was positively correlated with length of stay at time of review (r=0.69, p<0.01); this effect was predominantly carried by the social component of the IMSA score (r=0.86, p<0.01). Conclusion This pilot study has demonstrated that our use of a modified IMSA score is feasible. The modified tool demonstrated strong correlation with length of stay, indicating clinical utility. Our results highlight the high prevalence of complexity in this cohort and the adverse effect of social frailty on health outcomes and resource need. Further validation of this modified tool which amalgamates questionnaire with chart review is supported by our preliminary findings. Consideration should be given to interventions to ameliorate social frailty in this vulnerable cohort.
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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 | 0.013 | 0.027 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".