Progress with the INTERMED Self-Assessment (IMSA) Study: from European to international.

Background: “Complex” patients have one or more chronic medical illnesses and psychiatric/substance use comorbidity. They account for 50% of all health service use. The INTERMED method (INTERMED Complexity Assessment Grid – IMCAG) and its self-assessment version (IMSA) were developed to identify patients with multiple care risks/needs and negative health outcomes in order to support their integrated care. A multicentric research project is ongoing within the INTERMED working group of the EAPM, to test the IMSA's predictive validity, reliability and feasibility in research and clinical practice. Collaboration with the “360 Positive Care” HIV Clinic at the University of California, San Francisco was started, for inclusion as a research site. Objective: To provide an update on the progress of the IMSA study (IMSAS) about stage of involvement of research sites and preliminary results. Method: Features of recruiting sites, including ongoing preparation to enter the IMSAS (particularly the training on the use of IMCAG), stage of enrollment and problems encountered will be outlined. Also in view of its probable inclusion, the San Francisco research site will be discussed in some detail. Preliminary data on the subjects already assessed will be presented. Results: Research data on 454 patients enrolled at the sites of Modena, Amsterdam, Sion, Lausanne and Freiburg are already available, with 6-month follow-up data for 289 subjects (63.7%), as well as data from patients consenting to more informative clinical analyses. Preliminary analysis of 100% of the patients completing follow-up in Modena confirmed that the IMSA score positively correlates with indicators of complexity at follow-up. Additional resources have been developed at the San Francisco site for work with this patient population including a textbook authored by the presenters of this workshop describing a similar method for addressing problematic, high complexity cases (the MPCP method). Conclusions: According to our preliminary findings, the identification and management of clinical complexity associated with co-morbid systemic medical-psychiatric disorders, appears instrumental for providing effective and cost-effective care. The use of the INTERMED Complexity Assessment Grid ( IMCAG) and its self-assessment version (IMSA) appears both reliable and feasible for use in research and clinical practice.