Measuring Case Complexity on a Specialist Geriatric Subacute Frailty ward: A feasibility study of the INTERMED Self-Assessment questionnaire (IMSA)

Abstract Background The IMSA questionnaire is a validated tool which assesses the biopsychosocial complexity of patients across four domains (physical, mental, social, and healthcare). However, the self-assessment format is not always suitable for individuals with cognitive impairment. We aim to evaluate the feasibility of performing a modified IMSA score combining self-assessment and chart review on a frailty rehabilitation ward. Methods We carried out a pilot study with the IMSA (V1.0) questionnaire, utilising a combination of chart review and self-assessment questionnaires. Questionnaires were administered by various members of the multidisciplinary team. Descriptive statistics and Pearson’s correlation were used for our analysis. Results Self-assessment via questionnaire was performed with 15 patients. 5 patients were noted to have difficulty with self-reporting so chart review was used to supplement information on these patients. The assessment took a median time of 20 mins to complete (12-29). The median age in our cohort (n=15) was 87 (67-97), 12 of 15 were female (80%). The median IMSA score was 26 (15-43), with 80% of patients scoring ≥ 20 (indicating a high complexity). IMSA score was positively correlated with length of stay at time of review (r=0.69, p<0.01); this effect was predominantly carried by the social component of the IMSA score (r=0.86, p<0.01). Conclusion This pilot study has demonstrated that our use of a modified IMSA score is feasible. The modified tool demonstrated strong correlation with length of stay, indicating clinical utility. Our results highlight the high prevalence of complexity in this cohort and the adverse effect of social frailty on health outcomes and resource need. Further validation of this modified tool which amalgamates questionnaire with chart review is supported by our preliminary findings. Consideration should be given to interventions to ameliorate social frailty in this vulnerable cohort.