30 Chapter 2 Integral, Interdisciplinary and Medical (INTERMED) for the elderly To define the difficulty of each case, in the first round we asked the experts: What makes a case like this (not) difficult? We compared their responses with the information in the literature about the tools that measure case complexity, especially in geriatric patients. We found that INTERMED for the elderly best resembles the items named by the experts. INTERMED was developed originally to facilitate the description of case complexity for clinical and educational purposes (Huyse et al., 1999). Wild et al. (2011) stated that INTERMED for the elderly could be used to identify elderly patients in need of interdisciplinary care. The validity of the constructed cases is unknown. INTERMED delineates caring needs into four domains: biological, psychological, social and healthcare. Each domain has a maximum total score of 15. These four domains are structured based on time: history, current state and prognosis. The INTERMED for the elderly score ranges from 0 (not complex patients) to 60 (very complex patients). Based on the aspects presented in Table 2.2, we formulated six steps (Figure 2.2): • Three expert rounds (Steps 1, 3 and 5); • In between, the information is summarised by the researcher (Steps 2 and 4); • We added a pilot testing with students to assess the constructed cases (Step 6). Figure 2.2 shows what we did in each step to validate the content and scoring of each case.
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