title: Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire.
abstract: OBJECTIVE
  Forecasting hospitalization in patients with COPD has gained significant interest in the field of COPD care. There is a need to find simple tools that can help clinicians to stratify the risk of hospitalization in these patients at the time of care. The perception of quality of life has been reported to be independently associated with hospitalizations, but questionnaires are impractical for daily clinical use. Individual questions from valid questionnaires can have robust predictive abilities, as has been suggested in previous reports, as a way to use patient-reported outcomes to forecast important events like hospitalizations in COPD. Our primary aim was to assess the predictive value of individual questions from the Chronic Respiratory Questionnaire Self-Assessment Survey (CRQ-SAS) on the risk of hospitalization and to develop a clinically relevant and simple algorithm that clinicians can use in routine practice to identify patients with an increased risk of hospitalization.
  
  
  METHODS
  A total of 493 patients with COPD prospectively recruited from an outpatient pulmonary clinic completed the CRQ-SAS, demographic information, pulmonary function testing, and clinical outcomes. The cohort had a mean age of 70 years, was 54% male, with forced expiratory volume in 1 second percentage predicted 42.8±16.7, and modified Medical Research Council dyspnea scale score of 2±1.13.
  
  
  RESULTS
  Our analysis validated the original CRQ-SAS domains. Importantly, recursive partitioning analysis identified three CRQ-SAS items regarding fear or panic of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms that were highly predictive of hospitalization. We propose a robust (area under the curve =0.70) but short and easy algorithm for daily clinical care to forecast hospitalizations in patients with COPD.
  
  
  CONCLUSIONS
  We identified three themes - fear of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms - as important patient-reported outcomes to predict hospitalizations, and propose a short and easy algorithm to forecast hospitalizations in patients with COPD.
authors.affiliation: Pulmonary Division, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Abascal-Bolado
authors.affiliation: Department of Cancer Center Statistics, Health Science Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.affiliation: Department of Cancer Center Statistics, Health Science Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.affiliation: Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Karpman
authors.affiliation: Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Dulohery
authors.affiliation: Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Roberto P
authors.initials: RP
authors.lastname: Benzo
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000465:Algorithms; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D014481:United States
keywords: COPD; exacerbation; quality of life