Complexity in hospital internal medicine departments: What are we talking about?

Roberto Nardi, Franco Berti, Antonio Greco, Giovanni Scanelli, Paolo Leandri, Massimo Reta, Magda Mazzetti, Angelo Pasquale, Gelorma Belmonte, Mirco Magnani, Stefania Frasson, Concetta Baldo, Gualberto Gussoni, Giorgio Vescovo, Micaela La Regina, Mauro Campanini, Ido Iori, Giovanni Mathieu, Antonino Mazzone, Carlo Nozzoli

Research output: Contribution to journalArticlepeer-review


Internal medicine (IM) patients are mostly elderly, with multiple complex co-morbidities, usually chronic. The complexity of these patients involves the intricate entanglement of two or more systems (e.g. body and disease, family-socio-economic and environmental status, coordination of care and therapies) and this requires comprehensive, multi-dimensional assessment (MDA). Despite attempts to improve management of chronic conditions, and the availability of several MDA tools, defining the complex patient is still problematic. The complex profile of our patients can only be described through the best assessment tools designed to identify their characteristics. In order to do this, the Federation of Associations of Hospital Doctors on Internal Medicine FADOI has created its own vision of IM. This involves understanding the different needs of the patient, and analyzing diseases clusters and the possible relationships between them. By exploring the real complexity of our patients and selecting their real needs, we can exercise holistic, anthropological and appropriate choices for their treatment and care. A simpler assessment approach must be adopted for our complex patients, and alternative tools should be used to improve clinical evaluation and prognostic stratification in a hierarchical selection of priorities. Further investigation of complex patients admitted to IM wards is needed.

Original languageEnglish
Pages (from-to)142-155
Number of pages14
JournalItalian Journal of Medicine
Issue number3
Publication statusPublished - 2013


  • Assessment
  • Comorbidity
  • Complexity
  • Frailty
  • Internal medicine patient
  • Multimorbidity

ASJC Scopus subject areas

  • Medicine(all)


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