Performance Measure for Improvement in Dyspnea Data Definitions

Performance Measure for Improvement in Dyspnea

Data Definitions

Tools Used to Measure Dyspnea

These are well defined in the measure specifications and only include valid/reliable tools. This measure

stipulates the Modified Medical Research Council Scale, the University of California, San Diego Shortness

of Breath Questionnaire, and the Baseline and Transition Dyspnea Indices, as the tools for the measure.

Assessment should be completed within one week of PR program entry and within one week of PR

program completion.

Completion of PR

This measure defines participation in PR as completing at least 10 PR sessions within a 3 month period.

Patients who do not attend at least 10 PR sessions within a 3 month period are not considered to have

completed the PR program. However, the PR program can run longer than 3 months.

Denominator Exclusions

 Inability to complete the dyspnea screening instrument with reasonable accommodations

 Patient refusal to complete the intake and/or discharge dyspnea screening instrument

Minimum Clinical Important Difference (MCID)

The minimum change in score that has been correlated with a meaningful change in patient outcome.

According to Jaeschke, Singer and Guyatt (1989), the first to define the MCID, it is “the smallest

difference in score in the domain of interest which patients perceive as beneficial and which would

mandate, in the absence of troublesome side effects and excessive cost, a change in the patient's

management.” (p. 408).

Frequently Asked Questions

This performance measure focuses on the perception and impact of dyspnea across activities of daily

living. This measure does not focus on dyspnea rating at a specific point in time or during a specific

activity, but is rather a global measure of dyspnea. The Borg CR-10 (the Dr. Borg-approved tool) does

not address the focus of this measure. However, the clinical utility of use of symptom rating scales

remains an important clinical tool.

The Modified Medical Research Council (mMRC) is a single question instrument. It has been shown to be

valid and reliable. This tool is in the public domain and free to use.

Additional Details of the PR performance measures

See the AACVPR Pulmonary Rehabilitation Outcomes Toolkit (available under PR resources for

members) at www.aacvpr.org . Detailed information describing the tools, information regarding

licensing, costs, etc. is available here.