Home Monitoring for Early Detection of Chronic Disease Exacerbation (COPD)

Home Monitoring for Early Detection of
Chronic Disease Exacerbation.
OMB No. 2900-0770
Estimated Burden: 45 minutes
Expiration Date: 9/30/2019

The Paperwork Reduction Act of 1995: This information is collected in accordance with section 3507
of the Paperwork Reduction Act of 1995. Accordingly, we may not conduct or sponsor and you are not
required to respond to, a collection of information unless it displays a valid OMB number. We anticipate
that the time expended by all individuals who complete this survey will average 45 minutes. This includes
the time it will take to follow instructions, gather the necessary facts and respond to questions asked.
Customer satisfaction is used to gauge customer perceptions of VA services as well as customer
expectations and desires. The results of this telephone/mail survey will lead to improvements in the
quality of service delivery by helping to achieve services. Participation in this survey is voluntary and
failure to respond will have no impact on benefits to which you may be entitled.

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RM2003/00316/00

Completing the SGRQ
When the patient has completed the questionnaire, the coordinator should review it to
ensure that all questions have been answered. If any question is blank, double-check
with the patient without being critical.
Note that this assessment is a co-primary endpoint in this st udy. Therefore, it is
important that the SGRQ is fully completed by the patient.
If the study coordinator sees an answer that seems incorrect ( e.g., the patient marks that
he coughs a few days a month and it is documented that he coughs more often) do not
question its accuracy. By questioning a patient's answer, the coordinator is basically
telling the patient that he/she is wrong and the patient may change the original answer
even though he/she feels it was correct.
A copy of the SGRQ as well as a Guide to Completing the SGRQ is provided on the
following pages.
Questions or comments concerning the accuracy of the burden estimate and any
suggestions for reducing this burden should be sent to Rene Hearns, VA Northeast Ohio
Healthcare System at 216-791-2300 x45835.
Reference
1.

JONES PW, ET AL. 1992. A self-complete measure for chronic airflow
limitation, the St. George's Respiratory Questionnaire. Am Rev Respir Dis,
145, 1321-1327.

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