Identifying High-Cost, High-Risk Patients Using Administrative Databases in Tuscany, Italy

Table 1

Examples of elements of complexity found in the literature.

Dimension	Example	Sources	Number of studies
Medical/physical health	Functional impairment	[15, 19–23]	6
	Chronic symptoms	[24]	1
	Challenges in the application of clinical practice guidelines	[18, 25–29]	6
	Multimorbidity	[15, 30–44]	16
	Polypharmacy	[27, 45, 46]	3
Mental health	Mental health challenges, such as depression	[32, 47, 48]	3
	Psychological distress	[15, 32, 44, 49, 50]	5
	Cognitive impairment	[15, 51, 52]	3
	Substance use	[53, 54]	2
Social capital	Social health issues including caregiver strain	[55]	1
	Poor social support	[32, 56, 57]	5
	Relationship strain and lack of leisure time	[58]	1
Health and social experiences	Experiential challenges including poor quality of life	[32]	1
	Difficulty navigating services	[59]	1
	The need for a care manager	[60]	1
	Lack of access to providers	[57, 58]	2
	Heavy utilization of services	[28, 50, 56, 61]	4
	Higher healthcare costs	[50, 62–68]	8
Demographics	Demographic characteristics including advanced age	[15, 32, 69–72]	6
	Frailty	[21, 73, 74]	3
	Gender	[41, 44]	2
	Poverty	[15, 32, 41, 44, 75]	5
	Ethnic disparities	[76, 77]	2
	Lower level of education	[15, 32, 78]	3
Combined	One or some combination of social isolation, psychiatric illness, sociodemographic vulnerability, or other social and/or psychological difficulties	[79]	1
	Persistent distress or fear that is not adequately addressed and complicates medical management	[27]	1
	Symptom severity or impairments, diagnostic uncertainty, difficulty engaging care, lack of social safety or participation, disorganization of care, and difficult patient-clinician relationships	[16]	1