Journal of General Internal Medicine

, Volume 34, Issue 11, pp 2316–2318 | Cite as

Reproducibility in the Assessment of the Components of a Clinical Complexity Index

  • Marco Vincenzo Lenti
  • Catherine Klersy
  • Alice Silvia Brera
  • Irene Benedetti
  • Mariella Ciola
  • Giampiera Bertolino
  • Gino Roberto CorazzaEmail author
Concise Research Reports


Clinical complexity (CC) represents one of the most relevant challenges of modern medicine, and its quantification is crucial both to stratify the clinical risk and for a fair hospital reimbursement policy.1, 2, 3 CC is a multifaceted condition that encompasses biological (e.g., age, multimorbidity, frailty) and non-biological (e.g., socioeconomic, cultural, environmental, and behavioral) components.4, 5 On this basis, a vectorial model of CC has been set up in which each vector expresses the dynamic changes over time of each component.5 Although this model cannot but be an approximation of CC, it is able to take into account its determining factors all at once. To allow its use, each vector has been graded following a consensus meeting during which the five most representative variables of each CC domain were selected.6 However, a score made of a series of variables could be a source of variability. For this reason, we have performed an interobserver agreement study.




Clinical complexity


Confidence interval


Intraclass correlation coefficient



We thank Mr. Sturgeon for having proofread the paper.

Author Contributions

All authors participated in the drafting of the manuscript or critical revision of the manuscript for important intellectual content, and provided approval of the final submitted version. Individual contributions are as follow: GRC, MVL designed the study, organized data collection, and drafted the manuscript; MVL, ASB, IB conducted the study and enrolled patients; MC, GB, CK contributed to data collection and analysis; GRC made the final critical revision for important intellectual content. All authors approved the final version of the paper.


This research is part of a project for the study of clinical complexity funded by San Matteo Hospital Foundation - Italian Ministry of Health (Progetto di Ricerca Corrente 2017 - PI Prof. Gino Roberto Corazza).

Compliance with Ethical Standards

This study represents a sub-analysis of the San MAtteo Complexity study (NCT03439410) that was approved by the local Ethics Committee.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Marco Vincenzo Lenti
    • 1
  • Catherine Klersy
    • 2
  • Alice Silvia Brera
    • 1
  • Irene Benedetti
    • 1
  • Mariella Ciola
    • 1
  • Giampiera Bertolino
    • 1
  • Gino Roberto Corazza
    • 1
    • 3
    Email author
  1. 1.Department of Internal Medicine, Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
  2. 2.Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San MatteoUniversity of PaviaPaviaItaly
  3. 3.Medicina InternaFondazione IRCCS Policlinico San MatteoPaviaItaly

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