Clinical Assessment Tools need to be user friendly

Doctor-Patient contact time is vitally important for diagnosis and treatment.  To aid doctors thousands of ‘tools’ have been developed for use in various fields of medical practice.  But as new technology (including physical assessment and validated questionnaires) is introduced assessment tools become redundent and others are introduced. However technological advances tend to be expensive and time consuming to train medical staff to use.  It is also the case that they often require additional physical space, time to administer and a level of health of the patient.

CigarettesThe aim of Dr Rupert Jones and collegues (including me) was to derive a multi-component assessment index for use with patients with COPD to gain a measure of severity. The index was intended to include items that are clinically important, applicable to all grades of disease severity and all healthcare settings, and simple and clear to use.

Traditionally, the forced expiratory volume in one second (FEV1) has been the main measure of COPD severity for clinicians and still has a prominent place in international guidelines. While patients are mainly concerned with symptoms, exacerbations and functional capacity, airflow obstruction is important to clinicians in order to measure the lung damage and determine treatment. A composite measure could account for various dimensions of the disease, and take into account both the patient’s and the physician’s perspectives.

One highly regarded composite measure is the BODE index which was originally designed to predict mortality in COPD. However, the BODE index involves a Six Minute Walking Test (6MWT) which limits its use in routine clinical settings as it takes time, supervision, and space. Another validated prognostic index, the COPD Prognostic Index is also cumbersome to use in routine clinical settings as it includes seven items, one of which is a health status questionnaire.

Therefore we have derived and validated a composite index of severity in chronic obstructive pulmonary disease, which has recently been accepted for publication by the American Journal of Respiratory and Critical Care Medicine.  We hope the index will be widley adopted by the medical profession.

If you are unsure of its relevance or usfulness to your practice, below is the abstract associated with the journal article.


Rationale: COPD is increasingly recognized as a multi-component disease with systemic consequences and effects on quality of life. Single measures such as lung function provide a limited reflection of how the disease affects patients. Composite measures have the potential to account for many of the facets of COPD.

Objective: To derive and validate a multi-component assessment tool of COPD severity which is applicable to all patients and healthcare settings.

Methods/ Measurements: The index was derived using data from 375 COPD patients in primary care. Regression analysis led to a model explaining 48% of the variance in health status as measured by the Clinical COPD questionnaire with four components: dyspnea (D), airflow obstruction (O), smoking status (S) and exacerbation frequency (E). The DOSE index was validated in cross-sectional and longitudinal samples in different healthcare settings in Holland, Japan, and the United Kingdom.

Main results: The DOSE index correlated with health status in all datasets. A high DOSE index score (> = 4) was associated with a greater risk of hospital admission (odds ratio 8.3 (4.1 – 17) or respiratory failure 7.8 (3.4 – 18.3). The index predicted exacerbations in the subsequent year (p ≤ 0.014).

Conclusions: The DOSE index is a simple valid tool for assessing the severity of COPD. The index is related to a range of clinically important outcomes such as healthcare consumption and predicts future events.