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: 9334620
• 负责人: ROBERT B BANZETT
• 金额: $ 17.4万
• 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/9334620
• 关键词: Accreditation; 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; Development; Diagnosis; Dimensions; Discipline of Nursing; Disease; Distress; Dyspnea; 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; 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; Standardization; Symptoms; System; Systems Analysis; Testing; Thirst; Time; Time and Motion Studies; adverse outcome; appetite loss; body system; cohort; common symptom; cost; electronic data; end of life; end of life care; evidence base; experience; follow-up; improved; indexing; insight; malignant stomach neoplasm; mortality; novel; operation; patient population; prognostic; prognostic value; public health relevance; radiological imaging; response; symptom management; tool

DESCRIPTION: 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.

产品说明：呼吸急促（呼吸困难）既是威胁生命的疾病的预测指标，也是一种常见症状，如果没有得到充分的管理，会导致痛苦。疼痛是在认可的医疗机构进行常规评估;呼吸困难不是。我们假设，呼吸困难的常规测量可以是一个强大的工具来预测问题，目标干预，并管理不适，我们将在一个非常大的住院患者队列测试这一论文。 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，心脏病、胃肠癌和COPD），但令人惊讶的是，对综合医院人群中呼吸困难的患病率、严重程度和预测价值知之甚少。在目前的提案中，床旁护士将在45，000名新住院患者入院时进行标准化的呼吸困难评估，并在其中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例入院时有明显呼吸困难的患者中，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相关联-将为身体添加关键信息， 通过回答几个关键问题来了解：（1）在新住院患者的大队列中，呼吸困难测量是否独立地预测对患者和医疗保健系统重要的未来结果（例如，死亡、危重病发展、再次入院、患者满意度）？(Very初步结果表明，如果呼吸困难大于3/10，则风险大幅增加。）风险预测可用于根据风险进行更密切的监测 - 这样的随访可能包括更频繁地评估治疗、症状管理中所需的变化，以及对生命结束问题的积极计划。(2)住院患者呼吸困难的患病率、发生率、严重程度和时间进程如何？某些疾病是否有典型的呼吸困难的时间模式？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)在患者看来，什么是呼吸困难的充分治疗？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，并将呼吸困难评估纳入标准医院实践。标准化疼痛评估改变了我们对患者疼痛体验的看法。我们假设标准化的呼吸困难评估对我们评估患者的经验也有类似的作用，并且也有显著的预后价值。这一概念表明，以最低成本改善护理的机会很大。

项目成果

Routine dyspnea assessment on unit admission.

• DOI: 10.1097/01.naj.0000437112.43059.a0
• 发表时间: 2013-11
• 期刊: The American journal of nursing
• 作者: Baker K;Barsamian J;Leone D;Donovan BC;Williams D;Carnevale K;Lansing R;Banzett R
• 通讯作者: Banzett R

The Effect of Aerosol Saline on Laboratory-Induced Dyspnea.

• DOI: 10.1007/s00408-016-9971-3
• 发表时间: 2017-02
• 期刊: Lung
• 影响因子: 5
• 作者: O'Donnell CR;Lansing RW;Schwartzstein RM;Banzett R
• 通讯作者: Banzett R

Dyspnea, Acute Respiratory Failure, Psychological Trauma, and Post-ICU Mental Health: A Caution and a Call for Research.

• DOI: 10.1016/j.chest.2020.09.251
• 发表时间: 2021-03
• 期刊: Chest
• 影响因子: 9.6
• 作者: Worsham CM;Banzett RB;Schwartzstein RM
• 通讯作者: Schwartzstein RM

Routine dyspnea assessment and documentation: Nurses' experience yields wide acceptance.

• DOI: 10.1186/s12912-016-0196-9
• 发表时间: 2017
• 期刊: BMC nursing
• 影响因子: 3.2
• 作者: Baker KM;DeSanto-Madeya S;Banzett RB
• 通讯作者: Banzett RB

Multidimensional Dyspnea Profile: an instrument for clinical and laboratory research.

• DOI: 10.1183/09031936.00038914
• 发表时间: 2015-06
• 期刊: The European respiratory journal
• 作者: Banzett RB;O'Donnell CR;Guilfoyle TE;Parshall MB;Schwartzstein RM;Meek PM;Gracely RH;Lansing RW
• 通讯作者: Lansing RW