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# mnemonic QUESTION TEXT RESPONSE DEFINITIONS/DECISION RULES
         
1 copdspir Has the patient’s pulmonary function ever been assessed by spirometry? 1,2*

*If 2, go to copdmed, else go to copdspdt 		Ever = at any point in time. There is no retroactive time limit for this question.

Reference in the record to spirometry performed at any time in the past is acceptable to answer "1" to the question, even though the spirometry report may not be in the record.
2 copdspdt Enter the date the most recent spirometry was performed.

mm/dd/yyyy 		Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
3 spirodoc Are spirometry results documented in the medical record?
  1. % predicted value in record
  2. narrative description of spirometry outcome
  3. no spirometry results in record


1,2*,3**

*If 2, go to spironar

*If 3, go to copdmed, else go to copdfev 		This question references the spirometry performed on the above-noted date. If these results are unavailable, use results from any spirometry testing that may be accessible. This applies to results from a private-sector provider or progress notes describing results.

Severity of COPD Based on FEV1:

Mild: 50 to 79
Moderate: 35 to 49

Severe: < 35

Narrative description = must be described as "mild, moderate, or severe" and must be known to be from spirometry testing, e.g, "spirometry shows mild COPD."
4 copdfev Did the patient have an FEV1 value of greater than 50% of predicted? 1*,2**

*If 1, go to home02.

**If 2, go to copdmed 		The pulmonary function test (spirometry) report should contain the predicted or expected values for each component of the test.

Severity of COPD Based on FEV1:

Mild: 50 to 79
Moderate: 35 to 49

Severe: < 35
5 spironar Was the outcome of spirometry described as normal or only mild obstructive disease? 1*,2

*If 1, go to home02, else go to copdmed 		Narrative description = must be described as "mild, moderate, or severe" and must be known to be from spirometry testing, e.g, "spirometry shows mild COPD."

Normal = spirometry indicates respiratory function normal and patient does not have chronic obstructive lung disease
6 copdmed Was the patient prescribed an inhaled anticholinergic or beta2-agonist, either prior to or following spirometry testing?
  1. yes
  2. patient not on either medication
  3. no spirometry testing and/or outcome, but patient on one or both of these medications
1,2,3 No time restrictions apply.

The question references prescribed medication to be used for long-term therapy, not the bronchodilator used in spirometry testing

The patient may have been on an inhaled anticholinergic or beta2-agonist for a long period prior to the test, or one or both of these medications may have been prescribed as a result of the test.

If patient was on one or both of these medications prior to spirometry, but medication was discontinued after the test, answer "2."
7 home02 At the the most recent visit to an applicable clinic, was the patient on home oxygen therapy? 1,2**If 2, go out of module, else go to homeneed Home oxygen therapy may be referenced as LTOT (long-term oxygen therapy.)

If home O2 therapy is not noted at the most recent clinic visit, but is mentioned in an earlier visit, with no indication that O2 has been discontinued, answer 1."
8 homeneed Was the patient’s need assessed by pulse oximetry or ABGs prior to initiation of home oxygen therapy?
  1. pulse oximetry obtained
  2. arterial blood gases (ABGs) obtained
  3. neither pulse oximetry or ABGs obtained
  4. unable to determine
1,2*,3**,4**

*If 2, go to abgdate

**If 3 or 4, go to sixO2, else go to plseoxdt 		If the patient has been on home oxygen for a lengthy period of time, go back in the records five years in an attempt to determine when home oxygen therapy was initiated.

Use option #3 if the date the patient was first put on home O2 is known but need was not assessed by pulse oximetry or ABGs.

Use option #4 if unable to determine when the patient was first placed on home O2.

If both pulse oximetry and ABGs were done, use option #2 (ABGs)
9 plseoxdt Enter the date most immediately prior to initiation of home oxygen therapy that pulse oximetry was obtained. mm/dd/yyyy Patient may have had pulse oximetry measurement performed several times prior to initiation of home O2 therapy. Use the date closest to the date home O2 therapy was started.

Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
10 plseoxvl Enter the SaO2 value obtained on that date.

SaO2 = ______%Go to sixO2 		SaO2 = arterial oxygen saturation

Target of use 24 hrs/day to achieve SaO2 greater or equal 90 percent.
11 abgdate Enter the date most immediately prior to initiation of home oxygen therapy that ABGs were obtained. mm/dd/yyyy Patient may have had arterial blood gas measurement performed several times prior to initiation of home O2 therapy. Use the date closest to the date home O2 therapy was started.

Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
12 abgval Enter the PaO2 value obtained on that date.

PaO2 = _____ 		Target of use 24 hrs/day to achieve PaO2 greater or equal 60 percent.
13 sixO2 Was the patient on home oxygen for at least six months prior to the most recent clinic visit? 1,2*

*If 2, go out of module, else go to contneed 		For HBPC, "most recent clinic visit" corresponds to most recent home care visit.
14 contneed Was the need for continued home oxygen therapy assessed at least once during the most recent six-month period by pulse oximetry or ABGs?
  1. pulse oximetry obtained
  2. arterial blood gases (ABGs) obtained
  3. neither pulse oximetry or ABGs obtained


1,2*,3**

*If 2, go to abg6

**If 3, go out of module, else go to plseox6 		If both pulse oximetry and ABGs were done, use option #2 (ABGs)
15 plseox6 Enter the most recent date within the six-month period that pulse oximetry was obtained. mm/dd/yyyy Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
16 sixoxval Enter the SaO2 value obtained on that date.

SaO2 = ______%Go out of module 		SaO2 = arterial oxygen saturation

Target of use 24 hrs/day to achieve SaO2 greater or equal 90 percent.
17 abg6 Enter the most recent date within the six-month period that ABGs were obtained. mm/dd/yyyy Day may be entered as 01, if exact date is unknown. At a minimum, the month and year must be entered accurately.
18 abg6val Enter the PaO2 value obtained on that date.

PaO2 = _____ 		Target of use 24 hrs/day to achieve PaO2 greater or equal 60 percent.