Sullivan SS, Ledwin KM, Hewner S. A clinical classification framework for identifying persons with high social and medical needs: The COMPLEXedex-SDH.
Nurs Outlook 2023;
71:102044. [PMID:
37729813 PMCID:
PMC10842584 DOI:
10.1016/j.outlook.2023.102044]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND
First-generation algorithms resulted in high-cost features as a representation of need but unintentionally introduced systemic bias based on prior ability to access care. Improved precision health approaches are needed to reduce bias and improve health equity.
PURPOSE
To integrate nursing expertise into a clinical definition of high-need cases and develop a clinical classification algorithm for implementing nursing interventions.
METHODS
Two-phase retrospective, descriptive cohort study using 2019 data to build the algorithm (n = 19,20,848) and 2021 data to test it in adults ≥18 years old (n = 15,99,176).
DISCUSSION
The COMPLEXedex-SDH algorithm identified the following populations: cross-cohort needs (10.9%); high-need persons (cross-cohort needs and other social determinants) (17.7%); suboptimal health care utilization for persons with medical complexity (13.8%); high need persons with suboptimal health care utilization (6.2%).
CONCLUSION
The COMPLEXedex-SDH enables the identification of high-need cases and value-based utilization into actionable cohorts to prioritize outreach calls to improve health equity and outcomes.
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