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The Patient Centered Assessment Method (PCAM) is an action-based tool that supports professionals to engage in a biopsychosocial assessment with patients and measure their needs. It is a promising tool for person-centered care. As the Netherlands lacks such a tool, a Dutch version was developed. Furthermore, we aimed to contribute to the relatively limited insights into the psychometric properties and value of the tool when used as part of a needs assessment in primary care. Confirmatory factor analysis was used to study construct validity and Cronbach’s alpha was computed to assess reliability. Furthermore, we interviewed 15 primary care professionals who used the PCAM. It was confirmed that each PCAM domain measures a separate construct, informed by the biopsychosocial model. The tool showed adequate reliability (Cronbach’s alpha = 0.83). Despite face validity concerns, the tool was mainly valued for measurement of patient needs and to facilitate action planning. Criticism of the PCAM pertained to a limited focus on the patient perspective, which is one of the crucial aspects of person-centered care. These rich, mixed-method insights can help to improve the value of the PCAM, as one of the few multifunctional tools to support professionals in holistic assessments.

IntroductionPatients having chronic musculoskeletal pain (CMP) face challenges as mismatches often exist between the complexity of patient’s pain problem and the rehabilitation treatment offered. This can result in less efficient care for the patient and increased medical shopping. The Network Pain Rehabilitation Limburg (NPRL), a transmural integrated healthcare network, will be designed to improve daily care for patients with CMP. NPRL focusses on improving patient’s level of functioning despite pain by stimulating a biopsychosocial approach given by all involved healthcare professionals. A feasibility study will be performed which will give insight into the barriers and facilitators, perceived value, acceptability and implementation strategies for NPRL.Methods and analysisThis study has a three-phase iterative and incremental design, based on key principles of a user-centred design. Mixed methods will be used in which healthcare professionals and patients involved in NPRL will participate. In phase 1, NPRL will be developed and healthcare professionals educated. Phase 2 focusses on the implementation and phase 3 on the transferability of NPRL. In addition, preliminary data on patient’s work status, general health and participation level will be collected. The qualitative results of each phase will be analysed following the Consolidated Framework for Implementation Research (CFIR) and will be used to refine NPRL in daily practise.Ethics and disseminationInformed consent will be obtained from all participants. The results of this feasibility study will form the basis for refinement of NPRL and planning of a large-scale process and effect evaluation of the Quadruple Aim outcomes. Dissemination will include publications and presentations at national and international conferences. Ethical approval for this study was granted by the Medical Ethics Committee Z, the Netherlands, METC 17 N-133.

Objective: We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation.Method: One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety 8( Depression Scale (HADS).Results: We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS, MADRS, and mental and physical health scores of the SF-36 Health Survey.Conclusions: The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.

Objectives: The INFERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be provided as it supports professionals in their allocation decisions. The aim was to evaluate the measurement properties of the IM-E-SA.Methods: In this cross-sectional study 338 elderly people completed a postal questionnaire and participated in an interview. Feasibility of the IM-E-SA was assessed by determining the percentages of missing values per item. Reliability of the IM-E-SA was expressed as Cronbach's alpha. Intraclass correlation coefficients (ICCs) were calculated between the IM-E-SA and IM-E. Nonparametric tests were applied to assess if the IM-E-SA could distinguish between subgroups of elderly adults who differed on demographic characteristics and the prevalence of diseases/disorders. Convergent validity and discriminant validity were assessed using Spearman rank correlations between the IM-E-SA and IM-E, life satisfaction (Cantril's Ladder of Life), activities of daily living (Katz extended), quality of life (EQ-5D), mental health (SF-36) and prevalence of diseases/disorders.Results: Percentages of missing values per IM-E-SA item ranged from 0 to 5%. Cronbach's alpha was.78. The ICC between the total scores of the IM-E-SA and the IM-E was.68. The IM-E-SA yielded statistically significant differences between subgroups (known-group validity). Correlations evaluating the convergent validity were moderate to strong (.50-.70). Those correlations assessing the discriminant validity were moderate (.38-.53).Conclusion: This study supports the feasibility, reliability and validity of the IM-E-SA. (C) 2013 Elsevier Inc. All rights reserved.

Background: Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. Objective: The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation-liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. Method: Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N = 53) or to a nurse-led intervention (N = 47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. Results: The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. Conclusion: These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients. (Psychosomatics 2009; 50: 227-233)

BACKGROUND AND OBJETIVE: This study was aimed to verify whether it is possible to detect at hospital admission, by means of INTERMED, pneumonology patients at risk of "complexity" and of specialized psychosocial intervention.PATIENTS AND METHOD: With the Spanish version of INTERMED (for detection of risk for complexity of care) 144 patients were interviewed at admission by a standardized nurse. At discharge, patients were reassessed blindly with standardized Spanish versions of instruments including the Hospital Anxiety and Depression Scale (HADS). Somatic illness variables were independently documented, and severity was assessed by means of the Cummulative Illness Rating Scale. All variables were operationalized including complex (IM+; INTERIVIED > 20) and non-complex patients (IM-), and probable need of psychosocial treatment/intervention. Statistical analysis included multivariate logistic regression.RESULTS: A complex course was documented in 9.6% of patients, and 28.8% had complex discharge. Significantly higher proportions of severe anxiety and/or depression were documented in IM+ cases (12.1%) when compared to IM- cases (0.9%), and the need of psychosocial treatment/intervention was also significantly more frequent among the former (24.2% versus 6.3% respectively). Furthermore, in the multivariate analysis and controlling for medical and sociodemographic confounders INTERIVIED was significantly associated with the variable need of psychosocial intervention.CONCLUSIONS: In support of the clinical utility of the INTERMED method (Spanish version), this is the first report in the international literature documenting that standardized nurses are able to detect at admission those medical patients who will eventually need specialized psychosocial intervention.

Background: This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity. Methods: Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA1c levels (diabetic patients). Results: Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02). Conclusions: The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.

Background. Quality of life (QoL) in end-stage renal disease patients has become an important focus of attention in evaluating dialysis. We studied risk factors of poor QoL at 1 year follow-up.Methods. Of a baseline sample of 80 dialysis patients, we contacted 60 patients who were alive at 1 year follow-up. QoL data were obtained for 46 (76.7%) of these patients. QoL measured with the SF-36 [physical health component score (PCS) and mental health component score (MCS)] at 1 year-follow-up was predicted by means of multivariate regression analysis by data collected at baseline using INTERMED-an observer-rated method to assess biopsychosocial care needs-and several indicators for disease severity and comorbidity.Results. The regression models explained 32% of the variance in PCS and 40% in MCS. INTERMED score (P Conclusions. A simple risk score based on INTERMED, age (greater than or equal to 65) and comorbid diabetes (yes/no) can be used to detect patients at risk of poor QoL and non-survival at an early stage of treatment.

Objective: To analyse the value of the INTERMED, a screening instrument to assess case complexity, compared with the Expanded Disability Status Scale (EDSS) and the Guy's Neurological Disability Scale (GNDS) to identify multiple sclerosis (MS) patients in need of multidisciplinary treatment. Methods: One hundred MS patients underwent INTERMED, EDSS, and GNDS examinations. Patient care needs were assessed by a multidisciplinary team and a goal oriented treatment plan was defined. Correlations between INTERMED, individual INTERMED domains, EDSS, GNDS sum score, and total number of proposed disciplines involved in the treatment plan were studied. Results: Mean (SD) age was 40.6 (10.1) years. Median scores were 14.0 for the INTERMED, 4.0 for the EDSS, and 13.5 for the GNDS sum score. Moderate correlations were found between the INTERMED sum score and EDSS (r=0.59) and GNDS sum score (r=0.60). The number of disciplines as proposed by the multidisciplinary team showed the highest statistically significant correlation with the INTERMED sum score (r=0.41) compared with EDSS (r=0.32) and GNDS sum score (r=0.34). No significant or only weak correlations were found between the psychological domain of the INTERMED and, EDSS or GNDS. Conclusion: The findings in this study show that there is an additional value of the INTERMED compared with the EDSS and GNDS in identifying MS patients in need of multidisciplinary treatment. The INTERMED domains show the area of the patient's vulnerability and care needs: especially the INTERMED's psychological and social domains may guide the clinician to deal with specific problems that complicate healthcare delivery.

Aims and objectives. The relationship between mental disturbances-anxiety and depression, somatization and alcohol abuse-on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal Was to Study the utility of short screeners for mental disturbances to select patients for case-management on admission.Design. The study had a cohort design: patients were included oil admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor Study.Research methods and instruments. In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based oil the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care.Results. Patients with high scores oil anxiety and depression (SCL-8D) and on somatization received higher ratings oil perceived nursing complexity than those with low Scores, with and Without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, Could not explain these relations. No differences were found between patients with high or low scores oil alcohol abuse.Conclusions. The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between complexity indicators, highlighting differences between length of stay (LOS), objective complexity (such as medications or consultations), complexity ratings by the nurse, and complexity ratings by the doctor. Their findings illustrate illustrate limitations in the use of LOS as a sole indicator for care complexity. The authors show how objective and subjective complexity indicators can be used for early and valid detection of patients needing interdisciplinary care.

The authors developed a screening instrument to detect patients in need of complex care coordination at admission to a general hospital. On the basis of a series of risk factors for care complexity, the authors constructed a short, care complexity prediction instrument (COMPRI) and assessed its qualities. The COMPRI is an easily administered screening instrument that detects patients at risk for complex care needs for whom care coordination is indicated. COMPRI's predictive power exceeds all currently available case-mix instruments.

There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between complexity indicators, highlighting differences between length of stay (LOS), objective complexity (such as medications or consultations), complexity ratings by the nurse, and complexity ratings by the doctor. Their findings illustrate illustrate limitations in the use of LOS as a sole indicator for care complexity. The authors show how objective and subjective complexity indicators can be used for early and valid detection of patients needing interdisciplinary care.

Using the INTERMED, a system for classifying case complexity, the authors evaluated patients admitted to a general internal medicine ward on length of stay (LOS), number of medicines prescribed during the hospital stay, and whether they, had received specialist medical consults. Using the patients' INTERMED scores, the authors divided the patients into three clusters of patients: standard (n = 41), chronic (n = 26), and complex (n = 18). A comparison of the three clusters indicated that patients who had scored within the complex cluster were at risk of requiring complex care and an increased LOS. The findings suggest that the INTERMED detects complex patients at admission and may, therefore, be used for early integral case management.

The authors examined the timing of patient referrals to a psychiatric consultation-liaison service in relation to the patient's social vulnerability and level of psychiatric dysfunction. One hundred consecutive patients were assessed with the INTERMED, a method to document biopsychosocial and health care-related aspects of disease. Although 30% of patients were referred within the first day admission, 19% of requests for referrals were made after 2 weeks. Late referral was associated with high social vulnerability and early referral with severe psychiatric dysfunction. The authors illustrate the disadvantages of a psychiatric liaison model focusing on psychopathology alone and demonstrate the need for an integrated patient assessment in the general hospital focusing on detecting frail elderly patients.

IntroductionThe INTERMED has been developed in the past years asa method to assess case complexity and resulting care needsin order to foster coordinated and integrated health care [1–4]. The INTERMED is an observer-rated instrument thatclassifies information from a structured medical historytaking. We demonstrated its interrater reliability [1,5],validity [2], and clinical utility in detecting complex patientswith a diminished treatment response [3,4,6,7]. In this study,we studied its internal consistency in order to evaluate ifcase complexity as a one-dimensional construct is measuredreliably with the INTERMED.MethodsSampleData were derived from previously published studiesand studies in process, consisting of patients admitted tointernal medicine (n=302 andn=89) [4,10], patientsreferred to a CL-psychiatry service (n=100) [8], outpatientswith diabetes (n=61) [6], rheumatoid arthritis (n=75) [7],low back pain (n=102) [3], multiple sclerosis (n=152),under dialysis (n=80), and neurological outpatients(n=71). INTERMED scores of these 1032 patients weremerged and analyzed together.INTERMEDThe four domains of the INTERMED—biological, psy-chological, social, and health care—are assessed in thecontext of time (history, current state, and prognosis)resulting in 20 variables (see Fig. 1) that are scored 0–3based on a structured interview [9].Data analysisCronbach’s a as an indicator for internal consistency wascalculated for the total sample and for the individualsamples in order to evaluate the generalizability of thefindings. To further study the structure of the INTERMED,we calculated Pearson correlation coefficients amongdomain scores.ResultsAs illustrated in Table 1, the mean INTERMED scores ofthe different samples vary between 15.5 and 29.6 with lowback pain patients showing the highest biopsychosocialcomplexity. All a’s are above .75 indicating satisfactoryinternal consistency in each of the samples, with the highesta in the low back pain population. The a of the total sampleis .87 and between .86 and .89 with a 95% level ofconfidence interval.Correlations among the domain scores are significantlypositive correlated in all samples, except for three. In theCL-psychiatry sample, the biological domain score was notsignificantly correlated to the scores on the psychologicaland social domain. Also, in the diabetes sample, thebiological domain score was not significantly correlated tothe psychological domain. In the total sample, the lowest

Objectives: To enable prevention of poor outcome in elderly people, a valid instrument is required to detect individuals at high risk. The concept of frailty is a better predictor than age alone. The Groningen Frailty Indicator (GFI) has been developed to identify frailty. We assessed feasibility, reliability, and construct validity of the self-assessment version of the GFI.Design: Cross-sectional.Setting: Community-based.Participants: Home-dwelling and institutionalized elderly persons were included in the study (n = 353) who met the following inclusion criteria: persons 65 years and older who were able to fill out questionnaires.Measurements: The feasibility of the GFI was assessed by determining the proportion of missing values per item. The internal consistency reliability of the GFI was established by calculating the KR-20. Mann-Whitney and Kruskal-Wallis tests were applied to assess discrimination between specific subgroups (known group validity). Convergent and discriminant validity was assessed using Spearman Rank correlations between GFI and diseases and disorders, case complexity, and health care needs (INTERMED), life satisfaction (Cantril Ladder of Life), activities of daily living (Katz), quality of life (EQ-5D), and mental health (SF-36). Finally, we used multivariate regression analyses to evaluate the cutoff score of the GFI (= 4).Results: A total of 296 (84%) of the participants completed all items of the GFI; the internal consistency was 0.68. The GFI yielded statistically significant GFI scores for subgroups (known group validity). The correlations for the convergent (range 0.45 to 0.61) and discriminant validity (range 0.08 to 0.50) were also as hypothesized. In contrast with nonfrail participants, frail older persons had higher levels of case complexity, disability, and lower quality of life and life satisfaction.Conclusions: This study supports the feasibility, reliability, and validity of the self-assessment version of the GFI in home-dwelling and institutionalized elderly people. Copyright (C) 2012 - American Medical Directors Association, Inc.

Background: Depression is highly prevalent in patients with physical illness and is associated with a diminished quality of life and poorer medical outcomes. Objective: The authors evaluated whether a multifaceted intervention conducted by a psychiatric consultation-liaison nurse could reduce the incidence of major depression in rheumatology inpatients and diabetes outpatients with a high level of case complexity. Method: Of 247 randomized patients, the authors identified 100 patients with a high level of case complexity at baseline and without major depression (65 rheumatology and 35 diabetes patients). Patients were randomized to usual care (N = 53) or to a nurse-led intervention (N = 47). Main outcomes were the incidence of major depression and severity of depressive symptoms during a 1-year follow-up, based on quarterly assessments with standardized psychiatric interviews. Results: The incidence of major depression was 63% in usual-care patients and 36% in the intervention group. Effects of intervention on depressive symptoms were observed in outpatients with diabetes but not in rheumatology inpatients. Conclusion: These preliminary results based on subgroup analysis suggest that a multifaceted nurse-led intervention may prevent the occurrence of major depression in complex medically ill patients and reduce depressive symptoms in diabetes outpatients. (Psychosomatics 2009; 50: 227-233)

BACKGROUND AND OBJETIVE: This study was aimed to verify whether it is possible to detect at hospital admission, by means of INTERMED, pneumonology patients at risk of "complexity" and of specialized psychosocial intervention. PATIENTS AND METHOD: With the Spanish version of INTERMED (for detection of risk for complexity of care) 144 patients were interviewed at admission by a standardized nurse. At discharge, patients were reassessed blindly with standardized Spanish versions of instruments including the Hospital Anxiety and Depression Scale (HADS). Somatic illness variables were independently documented, and severity was assessed by means of the Cummulative Illness Rating Scale. All variables were operationalized including complex (IM+; INTERIVIED > 20) and non-complex patients (IM-), and probable need of psychosocial treatment/intervention. Statistical analysis included multivariate logistic regression. RESULTS: A complex course was documented in 9.6% of patients, and 28.8% had complex discharge. Significantly higher proportions of severe anxiety and/or depression were documented in IM+ cases (12.1%) when compared to IM- cases (0.9%), and the need of psychosocial treatment/intervention was also significantly more frequent among the former (24.2% versus 6.3% respectively). Furthermore, in the multivariate analysis and controlling for medical and sociodemographic confounders INTERIVIED was significantly associated with the variable need of psychosocial intervention. CONCLUSIONS: In support of the clinical utility of the INTERMED method (Spanish version), this is the first report in the international literature documenting that standardized nurses are able to detect at admission those medical patients who will eventually need specialized psychosocial intervention.

Because complex medical patients are a subgroup of the medical population and because complexity assessment involves extra effort, preselection of these patients through identifiers is necessary. There is no best identifier for complexity, and the one most suitable for the population served should be selected. This article provides a table with potential identifiers and discusses the difference between disease-oriented screening and treatment and a more generic approach such as complexity screening and complexity management.

Objective: Mental illness is prevalent among general hospital ward patients but often goes unrecognised. The aim of this study was to validate the SCL-8d as a brief questionnaire for mental disturbances for use in general hospitals. Methods: The study included 2040 patients, 18 years or older, consecutively admitted to 11 general internal medicine wards in seven European countries. All patients were screened on admission by means of the SCL-8d questionnaire. The psychometric performance (i.e., the internal validity) of the SCL-8d scale was tested using modern item response theory (IRT) in the form of the Rasch model. Results: Differences between sample characteristics were considerable. Even so, the SCL-8d scale showed a remarkable, statistically significant fit in terms of internal homogeneity (P>.01) in all individual settings, except in Spain and Germany where the item ‘‘Everything is an effort’’ had to be excluded to obtain a fit. When pooling data from all centres, an excellent statistical significance of fit (P > .05) was obtained by exclusion of the ‘‘Effort’’ item. The scale was homogeneous as to gender (P > .05), but not age as it performed better among young patients than among patients older than 60 years (P < .01). In these two patient groups both internal and external homogeneity (gender, median age) was achieved. The SCL-8d sum score showed a marked correlation with current and previous treatment for mental illness. Conclusion: Apart from the ‘‘Effort’’ item ranking differently on the latent severity dimension as to age, the SCL-8d seems very robust from a psychometric point of view. Besides being short, the SCL-8d scale contains only emotional symptoms. It would therefore seem to be an excellent diagnostic tool for use in medical settings.

Objective: The authors investigated the effects of implementing psychiatric interventions on a general medical ward by means of a stepped detection and treatment strategy conducted by a consultation-liaison (CL) nurse in terms of reducing length of hospital stay (LOS) and improving quality of life (QOL) at discharge. Materials and Methods: One hundred ninety-three patients participated in a controlled trial, in which patients were screened with COMPRI and INTERMED. A nurse under supervision of a CL psychiatrist conducted interventions, consisting of simple psychiatric interventions by herself, referral to auxiliary services, or initiation of postdischarge care. Intervention patients were compared with historic controls on LOS and QOL (SF36) at discharge. Results: In multivariate analysis of variance, a significant effect of the intervention on QOL (p = 0.037) was found, which diminished after controlling for confounders (p = 0.28). No significant effect on LOS was found for the whole sample (P = 0.72), but in patients age 65 years or older, a reduction in LOS (p = 0.05) was found. This effect remained after controlling for confounders (p = 0.06). Conclusions: These data suggest that screening for risk of increased health care might improve outcomes in general medical inpatients. Because of the design of the study, however, these findings should be considered preliminary and confirmed in a larger, multicenter, randomized controlled trial.

Using the INTERMED, a system for classifying case complexity, the authors evaluated patients admitted to a general internal medicine ward on length of stay (LOS), number of medicines prescribed during the hospital stay, and whether they, had received specialist medical consults. Using the patients' INTERMED scores, the authors divided the patients into three clusters of patients: standard (n = 41), chronic (n = 26), and complex (n = 18). A comparison of the three clusters indicated that patients who had scored within the complex cluster were at risk of requiring complex care and an increased LOS. The findings suggest that the INTERMED detects complex patients at admission and may, therefore, be used for early integral case management.

Aims and objectives. The relationship between mental disturbances - anxiety and depression, somatization and alcohol abuse - on admission to internal medicine units and perceived complexity of care as indicated by the nurse at discharge was studied. The goal was to study the utility of short screeners for mental disturbances to select patients for case-management on admission. Design. The study had a cohort design: patients were included on admission and followed through their hospital stay until discharge. The study was conducted within the framework of the European Biomed 1 Risk Factor study. Research methods and instruments. In the first 3 days of admission the patients were interviewed by a trained health care professional, who scored the SCL-8D, a somatization questionnaire based on the Whiteley-7 and the CAGE. At discharge, nurses rated the complexity of the patient's care. Results. Patients with high scores on anxiety and depression (SCL-8D) and on somatization received higher ratings on perceived nursing complexity than those with low scores, with and without control for age, severity of illness and chronicity. The actual nursing intensity and medical care utilization, as measured daily by means of a checklist, could not explain these relations. No differences were found between patients with high or low scores on alcohol abuse. Conclusions. The study shows a potential use of screeners for mental disturbances to detect patients for whom nurses might need additional help. However, mental disturbance is not the sole criterion: functional status and other variables that predict medical and nursing care utilization should be included in a screening strategy for case-management programmes.

The authors examined the timing of patient referrals to a psychiatric consultation-liaison service in relation to the patient's social vulnerability and level of psychiatric dysfunction. One hundred consecutive patients were assessed with the INTERMED, a method to document biopsychosocial and health care-related aspects of disease. Although 30% of patients were referred within the first day admission, 19% of requests for referrals were made after 2 weeks. Late referral was associated with high social vulnerability and early referral with severe psychiatric dysfunction. The authors illustrate the disadvantages of a psychiatric liaison model focusing on psychopathology alone and demonstrate the need for an integrated patient assessment in the general hospital focusing on detecting frail elderly patients.

During the last 10 years the INTERMED method has been developed as a generic method for the assessment of bio-psychosocial health risks and health needs and for planning of integrated treatment. The INTERMED has been conceptualized to counteract divisions and fragmentation of medical care. Designed to enhance the communication between patients and the health providers as well as between different professions and disciplines, the INTERMED is a visualized, action-oriented decision-support tool. This article presents various aspects of the INTERMED, such as its relevance, description, scoring, the related patient interview and treatment planning, scientific evaluation, implementation, and support for the method.

The authors developed a screening instrument to detect patients in need of complex care coordination at admission to a general hospital. On the basis of a series of risk factors for care complexity, the authors constructed a short, care complexity prediction instrument (COMPRI) and assessed its qualities. The COMPRI is an easily administered screening instrument that detects patients at risk for complex care needs for whom care coordination is indicated. COMPRI's predictive power exceeds all currently available case-mix instruments.

Objective: We investigated whether the INTERMED, a generic instrument for assessing biopsychosocial case complexity and direct care, identifies organ transplant patients at risk of unfavourable post-transplant development by comparing it to the Transplant Evaluation Rating Scale (TERS), the established measure for pretransplant psychosocial evaluation. Method: One hundred nineteen kidney, liver, and heart transplant candidates were evaluated using the INTERMED, TERS, SF-36, EuroQol, Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety 8( Depression Scale (HADS). Results: We found significant relationships between the INTERMED and the TERS scores. The INTERMED highly correlated with the HADS, MADRS, and mental and physical health scores of the SF-36 Health Survey. Conclusions: The results demonstrate the validity and usefulness of the INTERMED instrument for pretransplant evaluation. Furthermore, our findings demonstrate the different qualities of INTERMED and TERS in clinical practice. The advantages of the psychiatric focus of the TERS and the biopsychosocial perspective of the INTERMED are discussed in the context of current literature on integrated care.