[ { "key": "M5WBW5I8", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/M5WBW5I8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/M5WBW5I8", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Baird et al.", "parsedDate": "2013", "numChildren": 2 }, "data": { "key": "M5WBW5I8", "version": 5, "itemType": "bookSection", "title": "Working with Complexity in Integrated Behavioral Health Settings", "creators": [ { "creatorType": "author", "firstName": "Macaran A.", "lastName": "Baird" }, { "creatorType": "author", "firstName": "C. J.", "lastName": "Peek" }, { "creatorType": "author", "firstName": "William B.", "lastName": "Gunn" }, { "creatorType": "author", "firstName": "Andrew", "lastName": "Valeras" }, { "creatorType": "editor", "firstName": "Mary R.", "lastName": "Talen" }, { "creatorType": "editor", "firstName": "Aimee Burke", "lastName": "Valeras" } ], "abstractNote": "This chapter provides a practical approach for understanding and dealing with patient “complexity” in a health care context. Complexity is defined as the interaction of patient, provider, and care delivery variables, which intermingle to create situations where usual treatments are not working—or not working as well as patients and clinicians are expecting. These situations can only be understood by looking at the complex interaction of those variables and adopting new models of understanding and implementing new care-giving strategies. The chapter begins with a review of different approaches to dealing with complexity within the USA and in Europe. A particular method and clinical checklist is described in detail. A “real world” application, the Complex Continuity Clinic, using this and other methods of engaging patients in complex situations, is outlined, with clinical examples. Finally, the important implications of a complexity approach to emerging health care reform is described, shedding light on how effective approaches that embrace complex biopsychosocial health issues can result in greater quality and reduced costs.", "bookTitle": "Integrated Behavioral Health in Primary Care", "series": "", "seriesNumber": "", "volume": "", "numberOfVolumes": "", "edition": "", "date": "2013", "publisher": "Springer New York", "place": "", "originalDate": "", "originalPublisher": "", "originalPlace": "", "format": "", "pages": "299-324", "ISBN": "978-1-4614-6888-2 978-1-4614-6889-9", "DOI": "10.1007/978-1-4614-6889-9_14", "citationKey": "", "url": "http://link.springer.com/chapter/10.1007/978-1-4614-6889-9_14", "accessDate": "2016-07-12T13:01:09Z", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "en", "libraryCatalog": "link.springer.com", "callNumber": "", "rights": "©2013 Springer Science+Business Media New York", "extra": "", "tags": [ { "tag": "General Practice / Family Medicine", "type": 1 }, { "tag": "Health Psychology", "type": 1 }, { "tag": "Primary Care Medicine", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "JGW6GAVA", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/JGW6GAVA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/JGW6GAVA", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Wagner", "parsedDate": "1998-09", "numChildren": 1 }, "data": { "key": "JGW6GAVA", "version": 5, "itemType": "journalArticle", "title": "Chronic disease management: what will it take to improve care for chronic illness?", "creators": [ { "creatorType": "author", "firstName": "E. H.", "lastName": "Wagner" } ], "abstractNote": "", "publicationTitle": "Effective clinical practice: ECP", "publisher": "", "place": "", "date": "1998 Aug-Sep", "volume": "1", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "2-4", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Eff Clin Pract", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "10345255", "PMCID": "", "ISSN": "1099-8128", "archive": "", "archiveLocation": "", "shortTitle": "Chronic disease management", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Case Management", "type": 1 }, { "tag": "Chronic Disease", "type": 1 }, { "tag": "Comprehensive Health Care", "type": 1 }, { "tag": "Disease Management", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Outcome Assessment (Health Care)", "type": 1 }, { "tag": "Patient Care Team", "type": 1 }, { "tag": "Personal Health Services", "type": 1 }, { "tag": "Quality Assurance, Health Care", "type": 1 }, { "tag": "United States", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "XP6NM3PB", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/XP6NM3PB", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/XP6NM3PB", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Weiss", "parsedDate": "2007-12", "numChildren": 2 }, "data": { "key": "XP6NM3PB", "version": 5, "itemType": "journalArticle", "title": "Managing Complexity in Chronic Care: An overview of the VA State-of-the-Art (SOTA) Conference", "creators": [ { "creatorType": "author", "firstName": "Kevin B.", "lastName": "Weiss" } ], "abstractNote": "Introduction\nThe aging of the population and the increasing prevalence of multiple chronic illnesses, along with multiplying options for clinical management, pose great challenges to both the Veterans Health Administration (VHA) and the broader US health care system. Developing effective and efficient health care for persons with complex and multiple medical conditions is a national priority. Therefore, research in this area is critically important. In 2006, the VHA Health Services Research and Development Service held a state-of-the-Art (SOTA) conference titled “Managing Complexity in Chronic Care” to clarify our current understanding of the management of complex chronic conditions and suggest directions for research to better address this important problem.\n\nObjective\nThis article provides an overview of the major findings from that conference, including major presentations, summaries of the workgroup deliberations, and a list of research topics that were thought to be of highest importance to advancing our ability to provide medical care for persons with complex chronic care needs.", "publicationTitle": "Journal of General Internal Medicine", "publisher": "", "place": "", "date": "2007-12", "volume": "22", "issue": "Suppl 3", "section": "", "partNumber": "", "partTitle": "", "pages": "374-378", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Gen Intern Med", "DOI": "10.1007/s11606-007-0379-x", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150615/", "accessDate": "2016-07-08T14:29:33Z", "PMID": "18026804", "PMCID": "PMC2150615", "ISSN": "0884-8734", "archive": "", "archiveLocation": "", "shortTitle": "Managing Complexity in Chronic Care", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "SRD2GKEI", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/SRD2GKEI", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/SRD2GKEI", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Lorig et al.", "parsedDate": "2006-11", "numChildren": 1 }, "data": { "key": "SRD2GKEI", "version": 5, "itemType": "journalArticle", "title": "Internet-based chronic disease self-management: a randomized trial", "creators": [ { "creatorType": "author", "firstName": "Kate R.", "lastName": "Lorig" }, { "creatorType": "author", "firstName": "Philip L.", "lastName": "Ritter" }, { "creatorType": "author", "firstName": "Diana D.", "lastName": "Laurent" }, { "creatorType": "author", "firstName": "Kathryn", "lastName": "Plant" } ], "abstractNote": "BACKGROUND: The small-group Chronic Disease Self-Management Program (CDSMP) has proven effective in changing health-related behaviors and improving health statuses. An Internet-based CDSMP was developed to reach additional chronic-disease patients.\nOBJECTIVES: We sought to determine the efficacy of the Internet-based CDSMP.\nDESIGN: We compared randomized intervention participants with usual-care controls at 1 year. We compared intervention participants with the small-group CDSMP at 1 year.\nSUBJECTS: Nine-hundred fifty-eight patients with chronic diseases (heart, lung, or type 2 diabetes) and Internet and e-mail access were randomized to intervention (457) or usual care control (501).\nMEASURES: Measures included 7 health status variables (pain, shortness of breath, fatigue, illness intrusiveness, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 3 utilization variables (physician visits, emergency room visits, and nights in hospital), and self-efficacy.\nRESULTS: At 1 year, the intervention group had significant improvements in health statuses compared with usual care control patients. The intervention group had similar results to the small-group CDSMP participants. Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year.\nCONCLUSIONS: The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program.", "publicationTitle": "Medical Care", "publisher": "", "place": "", "date": "Nov 2006", "volume": "44", "issue": "11", "section": "", "partNumber": "", "partTitle": "", "pages": "964-971", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Med Care", "DOI": "10.1097/01.mlr.0000233678.80203.c1", "citationKey": "", "url": "", "accessDate": "", "PMID": "17063127", "PMCID": "", "ISSN": "0025-7079", "archive": "", "archiveLocation": "", "shortTitle": "Internet-based chronic disease self-management", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Adult", "type": 1 }, { "tag": "Aged, 80 and over", "type": 1 }, { "tag": "Chronic Disease", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Follow-Up Studies", "type": 1 }, { "tag": "Health Behavior", "type": 1 }, { "tag": "Health Status Indicators", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Internet", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Middle Aged", "type": 1 }, { "tag": "Outcome Assessment (Health Care)", "type": 1 }, { "tag": "Self Care", "type": 1 }, { "tag": "Self Efficacy", "type": 1 }, { "tag": "Surveys and Questionnaires", "type": 1 }, { "tag": "Time factors", "type": 1 }, { "tag": "aged", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "C4Q6NQHH", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/C4Q6NQHH", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/C4Q6NQHH", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Thorne", "parsedDate": "2006-03", "numChildren": 1 }, "data": { "key": "C4Q6NQHH", "version": 5, "itemType": "journalArticle", "title": "Patient-provider communication in chronic illness: a health promotion window of opportunity", "creators": [ { "creatorType": "author", "firstName": "Sally", "lastName": "Thorne" } ], "abstractNote": "As chronic illness takes its rightful place as an imperative for planners and policy makers globally, the obligation to provide appropriate self-care management support and promote optimal health among the chronically ill is attracting considerable attention. A generation of insider research into the chronic illness experience has yielded powerful evidence of the critical importance of communication between the chronically ill and those who provide their healthcare services. In this article, insights gained from the body of chronic illness research shape recommendations for attitudinal and structural adjustments that might steer our course toward promoting improved health for those affected by a chronic disease.", "publicationTitle": "Family & Community Health", "publisher": "", "place": "", "date": "2006 Jan-Mar", "volume": "29", "issue": "1 Suppl", "section": "", "partNumber": "", "partTitle": "", "pages": "4S-11S", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Fam Community Health", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "16344631", "PMCID": "", "ISSN": "0160-6379", "archive": "", "archiveLocation": "", "shortTitle": "Patient-provider communication in chronic illness", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Chronic Disease", "type": 1 }, { "tag": "Communication", "type": 1 }, { "tag": "Disabled Persons", "type": 1 }, { "tag": "Health Promotion", "type": 1 }, { "tag": "Health Services Research", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Patient Participation", "type": 1 }, { "tag": "Physician-Patient Relations", "type": 1 }, { "tag": "Self Care", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "5RHUXVQD", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/5RHUXVQD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/5RHUXVQD", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Sharma et al.", "parsedDate": "2014-01-01", "numChildren": 3 }, "data": { "key": "5RHUXVQD", "version": 5, "itemType": "journalArticle", "title": "Patients With High-Cost Chronic Conditions Rely Heavily on Primary Care Physicians", "creators": [ { "creatorType": "author", "firstName": "Manisha A.", "lastName": "Sharma" }, { "creatorType": "author", "firstName": "Newton", "lastName": "Cheng" }, { "creatorType": "author", "firstName": "Miranda", "lastName": "Moore" }, { "creatorType": "author", "firstName": "Megan", "lastName": "Coffman" }, { "creatorType": "author", "firstName": "Andrew W.", "lastName": "Bazemore" } ], "abstractNote": "Today's US physician workforce principally comprises specialists trained in the care of specific chronic conditions in the outpatient setting. However, a majority of patients seeking care for most of 14 high-cost chronic conditions, for example hypertension, were more likely to see a primary care physician than a specialist physician (69% vs. 24%, respectively).", "publicationTitle": "The Journal of the American Board of Family Medicine", "publisher": "", "place": "", "date": "01/01/2014", "volume": "27", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "11-12", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Am Board Fam Med", "DOI": "10.3122/jabfm.2014.01.130128", "citationKey": "", "url": "http://www.jabfm.org/content/27/1/11", "accessDate": "2016-07-08T14:52:17Z", "PMID": "24390880", "PMCID": "", "ISSN": "1557-2625, 1558-7118", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "en", "libraryCatalog": "www.jabfm.org", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Physician-Patient Relations", "type": 1 }, { "tag": "Quality of Health Care", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "494FZACT", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/494FZACT", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/494FZACT", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Lorig et al.", "parsedDate": "2001-12", "numChildren": 1 }, "data": { "key": "494FZACT", "version": 5, "itemType": "journalArticle", "title": "Effect of a self-management program on patients with chronic disease", "creators": [ { "creatorType": "author", "firstName": "K. R.", "lastName": "Lorig" }, { "creatorType": "author", "firstName": "D. S.", "lastName": "Sobel" }, { "creatorType": "author", "firstName": "P. L.", "lastName": "Ritter" }, { "creatorType": "author", "firstName": "D.", "lastName": "Laurent" }, { "creatorType": "author", "firstName": "M.", "lastName": "Hobbs" } ], "abstractNote": "CONTEXT: For patients with chronic disease, there is growing interest in \"self-management\" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases.\nOBJECTIVE: To evaluate outcomes of a chronic disease self-management program in a real-world\" setting.\nSTUDY DESIGN: Before-after cohort study.\nPATIENTS AND SETTING: Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data.\nINTERVENTION: The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building.\nMAIN OUTCOME MEASURES: Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires.\nRESULTS: At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant.\nCONCLUSIONS: We replicated the results of our previous clinical trial of a chronic disease self-management program in a \"real-world\" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.", "publicationTitle": "Effective clinical practice: ECP", "publisher": "", "place": "", "date": "2001 Nov-Dec", "volume": "4", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "256-262", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Eff Clin Pract", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "11769298", "PMCID": "", "ISSN": "1099-8128", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "PubMed", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "California", "type": 1 }, { "tag": "Chronic Disease", "type": 1 }, { "tag": "Cohort Studies", "type": 1 }, { "tag": "Decision making", "type": 1 }, { "tag": "Disease Management", "type": 1 }, { "tag": "Female", "type": 1 }, { "tag": "Health Education", "type": 1 }, { "tag": "Humans", "type": 1 }, { "tag": "Male", "type": 1 }, { "tag": "Program Evaluation", "type": 1 }, { "tag": "Quality Indicators, Health Care", "type": 1 }, { "tag": "Self Care", "type": 1 }, { "tag": "Surveys and Questionnaires", "type": 1 }, { "tag": "Treatment Outcome", "type": 1 }, { "tag": "United States", "type": 1 } ], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "7RKI7MVB", "version": 5, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/7RKI7MVB", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/7RKI7MVB", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Sevick et al.", "parsedDate": "2007-12", "numChildren": 2 }, "data": { "key": "7RKI7MVB", "version": 5, "itemType": "journalArticle", "title": "Patients with Complex Chronic Diseases: Perspectives on Supporting Self-Management", "creators": [ { "creatorType": "author", "firstName": "Mary Ann", "lastName": "Sevick" }, { "creatorType": "author", "firstName": "Jeanette M.", "lastName": "Trauth" }, { "creatorType": "author", "firstName": "Bruce S.", "lastName": "Ling" }, { "creatorType": "author", "firstName": "Roger T.", "lastName": "Anderson" }, { "creatorType": "author", "firstName": "Gretchen A.", "lastName": "Piatt" }, { "creatorType": "author", "firstName": "Amy M.", "lastName": "Kilbourne" }, { "creatorType": "author", "firstName": "Robert M.", "lastName": "Goodman" } ], "abstractNote": "A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed.", "publicationTitle": "Journal of General Internal Medicine", "publisher": "", "place": "", "date": "2007-12", "volume": "22", "issue": "Suppl 3", "section": "", "partNumber": "", "partTitle": "", "pages": "438-444", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Gen Intern Med", "DOI": "10.1007/s11606-007-0316-z", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2150604/", "accessDate": "2016-07-08T13:43:47Z", "PMID": "18026814", "PMCID": "PMC2150604", "ISSN": "0884-8734", "archive": "", "archiveLocation": "", "shortTitle": "Patients with Complex Chronic Diseases", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [ "XIVBAP4B" ], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "32TJ68ZR", "version": 4, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/32TJ68ZR", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/32TJ68ZR", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Bodenheimer T et al.", "parsedDate": "2002-10-09", "numChildren": 1 }, "data": { "key": "32TJ68ZR", "version": 4, "itemType": "journalArticle", "title": "IMproving primary care for patients with chronic illness", "creators": [ { "creatorType": "author", "name": "Bodenheimer T" }, { "creatorType": "author", "name": "Wagner EH" }, { "creatorType": "author", "name": "Grumbach K" } ], "abstractNote": "The chronic care model is a guide to higher-quality chronic illness management within primary care. The model predicts that improvement in its 6 interrelated components—self-management support, clinical information systems, delivery system redesign, decision support, health care organization, and community resources—can produce system reform in which informed, activated patients interact with prepared, proactive practice teams. Case studies are provided describing how components of the chronic care model have been implemented in the primary care practices of 4 health care organizations.", "publicationTitle": "JAMA", "publisher": "", "place": "", "date": "October 9, 2002", "volume": "288", "issue": "14", "section": "", "partNumber": "", "partTitle": "", "pages": "1775-1779", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "JAMA", "DOI": "10.1001/jama.288.14.1775", "citationKey": "", "url": "http://dx.doi.org/10.1001/jama.288.14.1775", "accessDate": "2016-07-08T14:45:27Z", "PMID": "", "PMCID": "", "ISSN": "0098-7484", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "Silverchair", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "KPBJAM6W", "version": 3, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/KPBJAM6W", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/KPBJAM6W", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Weiss", "parsedDate": "2007-11-16", "numChildren": 2 }, "data": { "key": "KPBJAM6W", "version": 3, "itemType": "journalArticle", "title": "Managing Complexity in Chronic Care: An overview of the VA State-of-the-Art (SOTA) Conference", "creators": [ { "creatorType": "author", "firstName": "Kevin B.", "lastName": "Weiss" } ], "abstractNote": "Introduction The aging of the population and the increasing prevalence of multiple chronic illnesses, along with multiplying options for clinical management, pose great challenges to both the Veterans Health Administration (VHA) and the broader US health care system. Developing effective and efficient health care for persons with complex and multiple medical conditions is a national priority. Therefore, research in this area is critically important. In 2006, the VHA Health Services Research and Development Service held a state-of-the-Art (SOTA) conference titled “Managing Complexity in Chronic Care” to clarify our current understanding of the management of complex chronic conditions and suggest directions for research to better address this important problem. Objective This article provides an overview of the major findings from that conference, including major presentations, summaries of the workgroup deliberations, and a list of research topics that were thought to be of highest importance to advancing our ability to provide medical care for persons with complex chronic care needs.", "publicationTitle": "Journal of General Internal Medicine", "publisher": "", "place": "", "date": "2007/11/16", "volume": "22", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "374-378", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J GEN INTERN MED", "DOI": "10.1007/s11606-007-0379-x", "citationKey": "", "url": "http://link.springer.com/article/10.1007/s11606-007-0379-x", "accessDate": "2016-07-17T21:19:42Z", "PMID": "", "PMCID": "", "ISSN": "0884-8734, 1525-1497", "archive": "", "archiveLocation": "", "shortTitle": "Managing Complexity in Chronic Care", "language": "en", "libraryCatalog": "link.springer.com", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "7V6B9NRM", "version": 3, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/7V6B9NRM", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/7V6B9NRM", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Safford et al.", "parsedDate": "2007-11-16", "numChildren": 2 }, "data": { "key": "7V6B9NRM", "version": 3, "itemType": "journalArticle", "title": "Patient Complexity: More Than Comorbidity. The Vector Model of Complexity", "creators": [ { "creatorType": "author", "firstName": "Monika M.", "lastName": "Safford" }, { "creatorType": "author", "firstName": "Jeroan J.", "lastName": "Allison" }, { "creatorType": "author", "firstName": "Catarina I.", "lastName": "Kiefe" } ], "abstractNote": "BACKGROUND The conceptualization of patient complexity is just beginning in clinical medicine. OBJECTIVES This study aims (1) to propose a conceptual approach to complex patients; (2) to demonstrate how this approach promotes achieving congruence between patient and provider, a critical step in the development of maximally effective treatment plans; and (3) to examine availability of evidence to guide trade-off decisions and assess healthcare quality for complex patients. METHODS/RESULTS The Vector Model of Complexity portrays interactions between biological, socioeconomic, cultural, environmental and behavioral forces as health determinants. These forces are not easily discerned but exert profound influences on processes and outcomes of care for chronic medical conditions. Achieving congruence between patient, physician, and healthcare system is essential for effective, patient-centered care; requires assessment of all axes of the Vector Model; and, frequently, requires trade-off decisions to develop a tailored treatment plan. Most evidence-based guidelines rarely provide guidance for trade-off decisions. Quality measures often exclude complex patients and are not designed explicitly to assess their overall healthcare. CONCLUSIONS/RECOMMENDATIONS We urgently need to expand the evidence base to inform the care of complex patients of all kinds, especially for the clinical trade-off decisions that are central to tailoring care. We offer long- and short-term strategies to begin to incorporate complexity into quality measurement and performance profiling, guided by the Vector Model. Interdisciplinary research should lay the foundation for a deeper understanding of the multiple sources of patient complexity and their interactions, and how provision of healthcare should be harmonized with complexity to optimize health.", "publicationTitle": "Journal of General Internal Medicine", "publisher": "", "place": "", "date": "2007/11/16", "volume": "22", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "382-390", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J GEN INTERN MED", "DOI": "10.1007/s11606-007-0307-0", "citationKey": "", "url": "http://link.springer.com/article/10.1007/s11606-007-0307-0", "accessDate": "2016-07-17T21:22:04Z", "PMID": "", "PMCID": "", "ISSN": "0884-8734, 1525-1497", "archive": "", "archiveLocation": "", "shortTitle": "Patient Complexity", "language": "en", "libraryCatalog": "link.springer.com", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [], "relations": {}, "dateAdded": "2016-09-09T10:56:50Z", "dateModified": "2016-09-09T10:56:50Z" } }, { "key": "EIXWT82H", "version": 3, "library": { "type": "group", "id": 689913, "name": "Patient Complexity_2", "links": { "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/689913/items/EIXWT82H", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/patient_complexity_2/items/EIXWT82H", "type": "text/html" } }, "meta": { "createdByUser": { "id": 274592, "username": "jintrone", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/jintrone", "type": "text/html" } } }, "creatorSummary": "Whittle and Bosworth", "parsedDate": "2007-11-16", "numChildren": 2 }, "data": { "key": "EIXWT82H", "version": 3, "itemType": "journalArticle", "title": "Studying Complexity is Complex", "creators": [ { "creatorType": "author", "firstName": "Jeff", "lastName": 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