Patient complexity: more than comorbidity. the vector model of complexity

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



Chronic Disease; Comorbidity; Delivery of Health Care; Health Status Indicators; Humans; *Outcome Assessment (Health Care); Physician-Patient Relations; *Quality of Health Care; *Self Care


Bioinformatics | Biostatistics | Epidemiology | Health Services Research


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.

DOI of Published Version



J Gen Intern Med. 2007 Dec;22 Suppl 3:382-90. Link to article on publisher's site

Journal/Book/Conference Title

Journal of general internal medicine

PubMed ID


Related Resources

Link to Article in PubMed