Transforming Care for Complex Patients: Addressing Interconnected Medical, Social, and Behavioral Challenges

Excerpt

For over half a century, scientists have examined the multitude of factors that influence healthcare utilization. In 1968, Ronald Andersen published a conceptual model describing how access to health services is influenced by patients’ predisposing, enabling and need characteristics, as he later wrote, “to assist the understanding of why families use health services; to define and measure equitable access to health care… and, not incidentally, to pass my dissertation committee at Purdue.”1 Others followed, further elucidating social, behavioral, and environmental contributors to health service use.1 ^– 3 More recently, aging population demographics and increasing chronic disease prevalence have intensified interest in clinical complexity and its consequences. In particular, rising rates of multimorbidity4—and associated risks of hospitalization, health care expenditure, and mortality5,6—have inspired efforts to understand the relationship between multiple concurrent medical diagnoses and future utilization and health outcomes. …