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Validity and reliability of the Patient Centred Assessment Method for patient complexity and relationship with hospital length of stay: a prospective cohort study
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  • Published on:
    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...

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    Conflict of Interest:
    None declared.
  • Published on:
    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...

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    Conflict of Interest:
    None declared.