Integrating the COMID tool in nursing and home care to enhance complexity management: How normalization process theory shapes patient care - A pilot study
Keywords:
COMID tool, complexity management, home healthcare, family and community nurse, multidimensional assessment, chronic disease screeningAbstract
Background and aim: The increasing complexity of home healthcare is driven by an aging population, the prevalence of chronic illnesses, and a growing need for patient-centred, multidimensional care. This study evaluates the feasibility of implementing the Complexity Measurement Instrument for Decision-making (COMID) within the Azienda USL Toscana Centro (AUSLTC) to improve complexity management.
Methods: COMID is a multidimensional tool assessing six domains: (1) medical factors, (2) socioeconomic factors, (3) mental circumstances, (4) behavioral factors, (5) instability circumstances, and (6) care network factors. The tool was integrated into AUSLTC's Family and Community Nurse (FCN) workflows following Normalization Process Theory (NPT), which provided a structured framework for adoption through training, stakeholder engagement, workflow integration, and continuous feedback. The study began with a simulation phase using hypothetical cases, followed by a two-month pilot study involving real patients to assess COMID’s feasibility, reliability, and effectiveness.
Results: The pilot included 106 patients, 47% of whom were classified as having medium or high complexity, with common issues like polymedication (74.5%) and health instability (60.4%). FCN feedback indicated that COMID is highly acceptable and feasible, promoting standardized patient assessments and effective interprofessional communication.
Conclusions: COMID's integration into AUSLTC's home care services improved complexity management through a structured, comprehensive approach. FCNs reported high levels of acceptability, appropriateness, and feasibility, enabling early complexity identification and supporting targeted, proactive interventions to prevent hospitalizations. COMID shows promise as an effective tool for managing complex home care situations in the Tuscany region.
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Copyright (c) 2025 Chiara Barchielli, Catherine Busnel, Catherine Ludwig , Fanny Vallet, Elena Lovicu , Marco Alaimo, Paolo Zoppi
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