Jump to comment:

• Re: Letter to the Editor – The INTERMED as a complexity assessment and intervention tool
  Shuhei Yoshida
  Published on: 15 August 2017
• Letter to the Editor – The INTERMED as a complexity assessment and intervention tool
  Friedrich Stiefel, Silvia Ferrari and Joris Slaets
  Published on: 13 July 2017

• Published on: 15 August 2017

  Re: Letter to the Editor – The INTERMED as a complexity assessment and intervention tool

  • Shuhei Yoshida, Family Physician Division of Clinical Epidemiology, Research Center for Medical Sciences, Jikei University School of Medicine, Tokyo, Japan

  Stiefel et al. presented much evidence concerning INTERMED. In addition to this, they presented a self-assessment version of the INTERMED (the IMSA). Indeed, INTERMED is an established tool for assessing complexity.

  The correlation between PCAM and INTERMED was shown in our article. Spearman’s rank correlation coefficient between these scores was 0.90, which indicates a strong correlation. This shows the possibility of using PCAM as a substitute for INTERMED.

  However, we recognize that INTERMED does not have obvious evidence in primary care because there are no published articles. In addition to this, Stiefel et al. pointed out the time issue for physicians. Time saving is not only useful for physicians but also other medical professions. The shortage and burnout of medical professions, including nurses, are problems in Japan and other countries[1-4]. If time for assessing anything can be saved appropriately, we think reasonably. As Stiefel et al. mentioned, another solution to resolve the time shortage is the self-administered version such as the IMSA; however, no self-administered test for measuring complexity exists in Japanese.

  We plan to study the relationships between the patient complexity and the burden of medical professions. To recognize PCAM as an established and feasible tool, many studies about PCAM are needed in future. We are glad to discuss the complexity. This concept is not major in Japan. We hope that the complexity will become to be...

  Show More

  Stiefel et al. presented much evidence concerning INTERMED. In addition to this, they presented a self-assessment version of the INTERMED (the IMSA). Indeed, INTERMED is an established tool for assessing complexity.

  The correlation between PCAM and INTERMED was shown in our article. Spearman’s rank correlation coefficient between these scores was 0.90, which indicates a strong correlation. This shows the possibility of using PCAM as a substitute for INTERMED.

  However, we recognize that INTERMED does not have obvious evidence in primary care because there are no published articles. In addition to this, Stiefel et al. pointed out the time issue for physicians. Time saving is not only useful for physicians but also other medical professions. The shortage and burnout of medical professions, including nurses, are problems in Japan and other countries[1-4]. If time for assessing anything can be saved appropriately, we think reasonably. As Stiefel et al. mentioned, another solution to resolve the time shortage is the self-administered version such as the IMSA; however, no self-administered test for measuring complexity exists in Japanese.

  We plan to study the relationships between the patient complexity and the burden of medical professions. To recognize PCAM as an established and feasible tool, many studies about PCAM are needed in future. We are glad to discuss the complexity. This concept is not major in Japan. We hope that the complexity will become to be more widespread through assessment tools such as INTERMED and PCAM. Thank you for your response to our article.

  1. Sawada A. The nurse shortage problem in Japan. Nursing Ethics 1997;4(3):245-52.
  2. Chan ZC, Tam WS, Lung MK, et al. A systematic literature review of nurse shortage and the intention to leave. Journal of nursing management 2013;21(4):605-13.
  3. Shi YY. A Survey of Occupational Therapy Practice in Beijing, China. Occupational therapy international 2016;23(2):186-95. doi: 10.1002/oti.1423
  4. OECD (2017), Doctors (indicator). doi: 10.1787/4355e1ec-en (Accessed on 31 July 2017)

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 13 July 2017

  Letter to the Editor – The INTERMED as a complexity assessment and intervention tool

  • Friedrich Stiefel, Psychiatrist Psychiatric Liaison Service, University Hospital, Lausanne, Switzerland
  • Other Contributors:
    • Silvia Ferrari, Psychiatrist
    • Joris Slaets, Geriatrician

  Yoshida et al. (1), comparing the PCAM with the INTERMED for the prediction of hospital length of stay (LOS), state (i) that the INTERMED “can be applied only to the secondary care setting” and (ii) is “relatively impractical” due to the length of the interview, and consider (iii) that the PCAM – with its “fewer items and simpler questions” – has “the potential to substitute for INTERMED”.

  First, the INTERMED has been and is utilised in the tertiary (2), secondary (3) and primary care setting (4). Second, assessing case complexity may need some time and a certain number of questions; the questions raised with the INTERMED have been validated by patients as being relevant (5) and the interview as having a positive effect (6). If physicians’ time is the issue: the INTERMED has been demonstrated good inter-rater reliability across medical professions (7) and is utilised in some settings by nurses (3). In addition, a self-assessment version of the INTERMED (the IMSA), reducing the length of the interview, has been validated in a recent multi-centred study (8). Third, when comparing the INTERMED with other instruments assessing case complexity, not only prediction of LOS has to be taken into account. The INTERMED provides a thorough biopsychosocial case complexity assessment (9); it has – unlike the PCAM, as acknowledged by the authors – been proven to be valid across various clinical settings (10) and to predict, in these settings, psychosocial, medical and health care...

  Show More

  Yoshida et al. (1), comparing the PCAM with the INTERMED for the prediction of hospital length of stay (LOS), state (i) that the INTERMED “can be applied only to the secondary care setting” and (ii) is “relatively impractical” due to the length of the interview, and consider (iii) that the PCAM – with its “fewer items and simpler questions” – has “the potential to substitute for INTERMED”.

  First, the INTERMED has been and is utilised in the tertiary (2), secondary (3) and primary care setting (4). Second, assessing case complexity may need some time and a certain number of questions; the questions raised with the INTERMED have been validated by patients as being relevant (5) and the interview as having a positive effect (6). If physicians’ time is the issue: the INTERMED has been demonstrated good inter-rater reliability across medical professions (7) and is utilised in some settings by nurses (3). In addition, a self-assessment version of the INTERMED (the IMSA), reducing the length of the interview, has been validated in a recent multi-centred study (8). Third, when comparing the INTERMED with other instruments assessing case complexity, not only prediction of LOS has to be taken into account. The INTERMED provides a thorough biopsychosocial case complexity assessment (9); it has – unlike the PCAM, as acknowledged by the authors – been proven to be valid across various clinical settings (10) and to predict, in these settings, psychosocial, medical and health care related outcomes (and not only LOS) (11). Moreover, when used as a tool to target early psychosocial interventions, the INTERMED was found to have a positive impact on such outcomes (2). Finally, the INTERMED is used in many European countries (8) and in different cultures (12). The authors’ statement that the “PCAM has the potential to substitute for INTERMED” is thus not supported by any evidence.

  References

  1. Yoshida S, Matsushima M, Wakabayashi H, et al. Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study. BMJ Open 2017;7:e016175. Doi:10.1136/bmjopen-2017-016175.
  2. Stiefel FC, Zdrojewski C, Bel Hadj F, et al. Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically ill: a Randomized Controlled Trial. Psychother Psychosom 2008; 77: 247-56 2008;77:247-256.
  3. Luthi F, Stiefel F, Gobelet Ch, Rivier G, Deriaz O. Rehabilitation outcomes for orthopaedic trauma individuals as measured by the INTERMED. Dis Rehab 2011; 33: 2544-52.
  4. www.intermedconsortium.com
  5. Guitteny-Collas M, Vanelle J.M, Bydlowski S, et al. Assessment of case complexity by means of the INTERMED: The users’point of view. 25th European Congress on Psychosomatic Research, Berlin 2004.
  6. Fischer CJ, Stiefel F, de Jonge et al. Case complexity and clinical outcome in diabetes mellitus: A prospective study using the INTERMED. Diabetes Metabol 2000; 26: 295-300.
  7. Huyse FJ, Lyons J, Stiefel F, et al. INTERMED: A method to assess health service needs: I. Development and first results on its reliability. Gen Hosp Psychiat 1999; 21: 39-48.
  8. Reedt Dortland A, van Peters L, Boenink A, et al. Assessment of biopsychosocial complexity and health care needs: measurement properties of the INTERMED self-assessment version (IMSA). Psychosom Med 2017; 79(4): 485-92.
  9. de Jonge P, Huyse FJ, Slaets JPJ, et al. Operationalization of biopsychosocial case complexity in general health care: the INTERMED project. Australian and New Zealand Journal of Psychiatry 2005; 39: 795-799.
  10. Stiefel F, de Jonge P, Huyse F et al. INTERMED: A method to assess health service needs: II. Results on its validity and clinical use. Gen Hosp Psychiat 1999; 21: 49-56.
  11. De Jonge P, Stiefel F. Internal consistency of the INTERMED in patients with somatic diseases. J Psychosom Res 2003; 54:497-499.
  12. Kishi Y, Matsuki M. Mizushima H, et al. The INTERMED Japanese version: inter-rater reliability and internal consistency. J Psychosom Res 2010;69: 583-586.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top