Development and validation of a screening tool for chronic obstructive pulmonary disease in nursing home residents.

摘要

OBJECTIVES: The purpose of the study was to develop and validate a simple caregiver-rated questionnaire to screen for chronic obstructive pulmonary disease (COPD) in nursing home residents. DESIGN: Part 1: Identification of screening parameters by the Delphi process using geriatric and pulmonary experts. Part 2: Retrospective analysis of nursing home residents with COPD compared with a gender and age frequency-matched control group of nursing home residents. SETTING: Twelve skilled nursing facilities in Arizona, California, Illinois, Maryland, Missouri, and Ohio. PARTICIPANTS: Nine geriatric and pulmonary experts participated in the identification of screening parameters in Part 1. In Part 2, validation occurred in 64 nursing home residents with COPD and 64 nursing home residents without COPD. INTERVENTION: Retrospective analysis of medical records. MEASUREMENTS: A linear logistic regression routine was used with a stepwise algorithm to identify a "best" set of variables predicting the presence of COPD. The list of variables chosen was then used to define a predictive role for COPD. This role was then characterized by its screening characteristics of sensitivity and specificity. RESULTS: The logistic model identified 4 significant COPD screening parameters: diagnosis of asthma (P = .013), shortness of breath at rest (P = .004) and shortness of breath on exertion (P = .001), and smoking fewer than 19 pack-years (P = .005) or greater than or equal to 19 pack-years (P = .001), with an area-under-the-curve of 0.903. CONCLUSIONS: Nursing home residents with a diagnosis of asthma and have shortness of breath or have been smokers are likely to have COPD.