Quantifying a Vital Symptom: Large-scale Inpatient Dyspnea Measurement

量化重要症状：大规模住院患者呼吸困难测量

• 批准号: 8632034
• 负责人: ROBERT B BANZETT
• 金额: $ 43.5万
• 依托单位: BETH ISRAEL DEACONESS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-19 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8632034
• 关键词: Admission activity; Adopted; Cardiac; Caring; Cessation of life; Characteristics; Chronic Obstructive Airway Disease; Client satisfaction; Clinical; Clinical Data; Collaborations; Computerized Medical Record; Critical Illness; Data; Databases; Desire for food; Development; Diagnosis; Dimensions; Discipline of Nursing; Disease; Distress; Dyspnea; Electronics; Emotional; Epidemiology; Esthesia; Evaluation; Evolution; Fatigue; Feedback; Focus Groups; Foundations; Future; General Hospitals; Goals; Health Personnel; Healthcare; Healthcare Systems; Heart Diseases; Heart failure; Hospital Nursing; Hospitalization; Hospitals; Hunger; Image; Incidence; Inpatients; Institution; Intervention; Knowledge; Laboratories; Length of Stay; Life; Link; Malignant neoplasm of esophagus; Malignant neoplasm of gastrointestinal tract; Measurement; Measures; Medical; Metabolic; Monitor; Morbidity - disease rate; Nausea; Needs Assessment; Nurses; Outcome; Outcome Measure; Oxygen; Pain; Pain Measurement; Panic; Pathway interactions; Patients; Pattern; Physicians; Population; Predictive Value; Prevalence; Public Health; Pulmonary Embolism; Pulmonary Emphysema; Pulmonary Function Test/Forced Expiratory Volume 1; Quality of life; Questionnaires; Records; Reporting; Research; Resource Allocation; Risk; Sensory; Severities; Shortness of Breath; Symptoms; System; Systems Analysis; Testing; Thirst; Time; Time and Motion Studies; adverse outcome; base; body system; cohort; cost; electronic data; end of life; evidence base; experience; follow-up; improved; indexing; malignant stomach neoplasm; mortality; novel; operation; patient population; prognostic; public health relevance; response; symptom management; tool

PROJECT SUMMARY Shortness of breath (Dyspnea) is both a predictor of life-threatening illness and a common symptom that causes suffering if not adequately managed. Pain is routinely assessed in accredited healthcare institutions; dyspnea is not. We hypothesize that routine measurement of dyspnea can be a powerful tool to predict problems, target interventions, and manage discomfort; we will test this thesis in a very large cohort of hospitalized patients. Dyspnea is one the strongest predictors of death in a variety of narrow disease populations (e.g., cardiac disease, gastrointestinal cancer, and COPD), but surprisingly little is known about the prevalence, severity, and predictive value of dyspnea in the general hospital population. In the present proposal, bedside nurses will perform standardized dyspnea assessments at the time of admission in 45,000 newly hospitalized patients and will assess dyspnea twice each day over the course of the hospital stay in 12,000 of these patients. Dyspnea will be measured as a continuous variable, rather than a binary yes/no variable. In 2,000 of these patients with significant dyspnea at admission, research staff will make more detailed multidimensional dyspnea measurements, tracking dyspnea through the course of hospitalization. These cohorts - linked to detailed electronic medical record data -- will add critical information to the body of knowledge by answering several key questions: (1) In a large cohort of newly hospitalized patients, does dyspnea measurement independently predict future outcomes that are important to patients and the healthcare system (e.g., death, development of critical illness, readmission, patient satisfaction)? (Very preliminary results suggest a large increase in risk if dyspnea is greater than 3/10.) Risk predictions could be used to target closer monitoring on the basis of risk - such follow-up might include more frequent assessment for needed changes in therapy, symptom management, and pro-active planning for end-of-life issues. (2) What is the prevalence, incidence, severity, and time course of dyspnea in hospitalized patients? Do some diseases have typical temporal patterns of dyspnea? Are particular qualities of dyspnea associated with greater emotional burden or greater morbidity? (3) What is the burden of dyspnea measurement on health care providers? (4) What constitutes adequate treatment of dyspnea in the view of patients? This project will provide a novel evidence base for policymakers to use in setting goals for dyspnea treatment in hospitalized patients and incorporating dyspnea assessment into standard hospital practice. Standardizing the assessment of pain has changed how we think about the patient's experience of pain. We hypothesize that standardized dyspnea assessment will have a similar effect on our appreciation of the patient's experience, and will also have dramatic prognostic value. This concept suggests a large opportunity for improving care with minimal cost.

项目摘要 呼吸急促（呼吸困难）既是威胁生命的疾病的预测因子，也是一种常见症状， 如果管理不当会造成痛苦。疼痛在认可的医疗机构进行常规评估; 呼吸困难不是。我们假设，常规测量呼吸困难可以作为预测 问题，目标干预措施和管理不适;我们将在一个非常大的队列中测试这一论点， 住院患者。 呼吸困难是各种狭窄疾病人群中死亡的最强预测因子之一（例如，心脏 疾病，胃肠癌和COPD），但令人惊讶的是，关于其患病率，严重程度和 综合医院人群呼吸困难的预测价值。在目前的建议中，床边护士将 在45，000名新住院患者入院时进行标准化呼吸困难评估， 将在12,000名患者住院期间每天评估两次呼吸困难。呼吸困难 将作为连续变量进行测量，而不是二元是/否变量。在2,000名患有 入院时出现明显呼吸困难，研究人员将进行更详细的多维呼吸困难 测量，在住院期间跟踪呼吸困难。这些队列-与详细的 电子医疗记录数据-将通过回答几个问题， 关键问题：（1）在一个新住院患者的大队列中，呼吸困难测量是否独立 预测对患者和医疗保健系统重要的未来结果（例如，死亡，发展 危重病、再入院、患者满意度）？(Very初步结果表明，如果 呼吸困难大于3/10）。风险预测可用于根据风险进行更密切的监测- 这种随访可能包括更频繁地评估治疗、症状 管理，并积极规划寿命结束问题。(2)什么是患病率，发病率，严重程度， 住院患者呼吸困难的时间进程？某些疾病是否具有典型的时间模式 呼吸困难？呼吸困难的特殊性质是否与更大的情绪负担或更高的发病率有关？ (3)呼吸困难测量对卫生保健提供者的负担是什么？(4)什么是充分 从患者的角度来看，如何治疗呼吸困难？该项目将为决策者提供一个新的证据基础 用于设定住院患者呼吸困难治疗的目标，并纳入呼吸困难评估 标准的医院实践。标准化的疼痛评估改变了我们对疼痛的看法。 患者的疼痛体验。我们假设标准化的呼吸困难评估也会有类似的效果 根据我们对病人的经验的评价，也将有巨大的预后价值。这个概念 这意味着以最小的成本改善护理的机会很大。