A method to provide integrated care for complex medically ill patients: the INTERMED.

A growing number of nursing subspecializations have been developed in recent decades. Topics of concern are that care is not tailored to cope with the growing number of patients with more than one chronic disease, there is an increase in co-ordination problems in the care that is provided for this group of complex patients, and the care for these complex patients is extremely fragmented. The assessment of health risks resulting in co-ordinated care with effective communication is vital for multimorbid patients. Our aim is to describe a systematic approach (the INTERMED [IM] method) to identify complex patients who are in need of integrated care and its applicability to the nursing process. We demonstrate the ability of the IM method to quantify, weigh, and classify the complexity of problems. The method is applied in Europe and will be started in the USA in a pharmacy program. The IM is presented as a decision-support system for multidisciplinary teams with nurse co-ordinators.