title: How well do patients and providers agree on the severity of dyspnea?
abstract: Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions.
  
  
  
  To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment.
  
  
  
  Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital.
  
  
  
  A numerical rating scale (0-10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over- or underestimations. The relationship between patient self-perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient.
  
  
  
  Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient-physician and 138 patient-nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance.
  
  
  
  Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701-707. © 2016 Society of Hospital Medicine.
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts. mihaela.stefan@baystatehealth.org.|Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts. mihaela.stefan@baystatehealth.org.|Tufts Clinical and Translational Science Institute, Boston, Massachusetts. mihaela.stefan@baystatehealth.org.|Tufts University School of Medicine, Boston, Massachusetts. mihaela.stefan@baystatehealth.org.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Aruna
authors.initials: A
authors.lastname: Priya
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Martin
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.|School of Public Health & Health Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts.
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.affiliation: Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Division of Epidemiology of Chronic Diseases & Vulnerable Populations and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts.
authors.forename: Ernest
authors.initials: E
authors.lastname: DiNino
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts.|Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts.|Tufts Clinical and Translational Science Institute, Boston, Massachusetts.|Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D057566:Self Report; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires