ID

32960

Beschreibung

CORONARY ARTERY DISEASE DATA COLLECTION Version 2.0.3 Revised: April 5th, 2017 International Consortium for Health Outcomes Measurement (ICHOM), Source: http://www.ichom.org/ Conditions: Asymptomatic Coronary Artery Disease | Stable Angina | Acute Coronary Syndrome (Includes AMI) Treatment Approaches: Lifestyle Modification | Drug Therapy | Percutaneous Coronary Intervention (PCI) | Coronary Artery Bypass Grafting (CABG) This form contains baseline clinical items. Some of the items may additionally be reported from administrative sources. It may be filled out in an outpatient setting in case of diagnosis of a stable angina or at diagnosis in an inpatient setting. Questionnaires used in this standard set: Rose Dyspnea Scale: The Rose Dyspnea Scale is free for all health care organizations, and a license is not needed. More information may be found at http://www.ahjonline.com/article/S0002-8703(09)00266-X/abstract Patient Health Questionnaire (PHQ-2): The PHQ-2 is free for all health care organizations, and a license is not needed. Copyright Pfizer, more Information on http://www.phqscreeners.com/ Seattle Angina Questionnaire (SAQ-7): Due to the need for a license for use of the SAQ-7 the actual questions of SAQ-7 will not be part of this version of the standard set. Publication: McNamara RL, Spatz ES, Kelley TA, et al. Standardized Outcome Measurement for Patients With Coronary Artery Disease: Consensus From the International Consortium for Health Outcomes Measurement (ICHOM). J Am Heart Assoc. 2015;4(5):e001767. Published 2015 May 19. doi:10.1161/JAHA.115.001767

Link

http://www.ichom.org/

Stichworte

Versionen (7)
  1. 27.11.17 27.11.17 -
  2. 27.11.17 27.11.17 -
  3. 04.12.17 04.12.17 -
  4. 07.12.17 07.12.17 -
  5. 08.12.17 08.12.17 -
  6. 22.11.18 22.11.18 - Sarah Riepenhausen
  7. 30.04.20 30.04.20 - Sarah Riepenhausen
Rechteinhaber

ICHOM

Hochgeladen am

22. November 2018

DOI

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Creative Commons BY-NC 3.0
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ICHOM Coronary Artery Disease

Englisch

Baseline Clinical Form

1 Formulare  
  1. StudyEvent: ODM
    1. Baseline Clinical Form
Administrative Data
Beschreibung

Administrative Data

Alias
UMLS CUI-1
C1320722
Indicate the patient's medical record number
Beschreibung

This number will not be shared with ICHOM. In the case patient-level data is submitted to ICHOM for benchmarking or research purposes, a separate ICHOM Patient Identifier will be created and cross-linking between the ICHOM Patient Identifier and the medical record number will only be known at the treating institution INCLUSION CRITERIA: All patients TIMING: On all forms REPORTING SOURCE: Administrative or clinical TYPE: Numerical RESPONSE OPTIONS: According to institution

Datentyp

integer

Alias
UMLS CUI [1]
C1269815
Demographic factors
Beschreibung

Demographic factors

Alias
UMLS CUI-1
C1704791
What is your date of birth?
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Patient-reported, clinical, or administrative data TYPE: Date by DD/MM/YYYY

Datentyp

date

Maßeinheiten
  • DD/MM/YYYY
Alias
UMLS CUI [1]
C0001779
UMLS CUI [2]
C0421451
DD/MM/YYYY
Please indicate your sex at birth
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Patient-reported, clinical, or administrative data TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1]
C0079399
Baseline health status
Beschreibung

Baseline health status

Alias
UMLS CUI-1
C1442488
UMLS CUI-2
C0449440
Indicate if the patient has had at least one documented previous myocardial infarction at any point in their history
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0027051
Indicate if the patient has a documented history of heart failure
Beschreibung

Heart failure is defined as physician documentation or report of any of the following clinical symptoms of heart failure described as unusual dyspnea on light exertion, recurrent dyspnea occurring in the supine position, fluid retention; or the description of rales, jugular venous distension, pulmonary edema on physical exam, or pulmonary edema on chest x-ray presumed to be cardiac dysfunction. A low ejection fraction alone, without clinical evidence of heart failure does not qualify as heart failure INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0018802
Indicate whether the patient has a documented history of hypertension diagnosed and treated with medication and/or diet and/or exercise
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0020538
Indicate whether the patient has a documented history of stroke
Beschreibung

Stroke is defined as any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain that did not resolve within 24 hours INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0038454
Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents)
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0011849
Indicate if the patient is insulin dependent
Beschreibung

INCLUSION CRITERIA: All patients, If answered 'yes' to patient having a documented history of diabetes mellitus (DIAB) TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0011854
Indicate whether the patient has a history of peripheral arterial disease
Beschreibung

Includes upper and lower extremity, renal, mesenteric, and abdominal aortic systems evidenced by a documented history of 1. Peripheral arterial disease and/or 2. Claudication, either with exertion or at rest, and/or 3. Amputation for arterial vascular insufficiency, and/or 4. Vascular reconstruction, bypass surgery, or percutaneous intervention to the extremities (excluding dialysis fistulas and vein stripping), and/or 5. Documented aortic aneurysm with or without repair. Peripheral arterial disease excludes disease in the carotid or cerebrovascular arteries INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1]
C1881056
Indicate whether the patient is dialysis dependent
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1]
C0524376
Indicate the patient’s baseline creatinine level
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical TYPE: Numerical value RESPONSE OPTIONS: Absolute numerical value of baseline creatinine level (include units)

Datentyp

float

Alias
UMLS CUI [1]
C0201975
Indicate units of baseline creatinine level
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0201975
UMLS CUI [1,2]
C1519795
Indicate whether the patient has a chronic lung disease
Beschreibung

Including but not limited to COPD and asthma INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1]
C1533075
Indicate if the patient is oxygen dependent
Beschreibung

INCLUSION CRITERIA: All patients, If answered 'yes' to patient having a chronic lung disease (CHRONLD) TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0030054
UMLS CUI [1,3]
C0439857
Indicate whether the patient has a history of cirrhosis
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0023890
Indicate whether the patient has a history of dementia
Beschreibung

Including but not limited to, Alzheimer’s disease, vascular dementia, lewy body dementia and frontotemporal dementia INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical (Where possible, we also recommend the collection of comorbidities via administrative data to allow for comparisons in coverage and validity.) TYPE: Single answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0497327
Indicate presenting creatinine level
Beschreibung

INCLUSION CRITERIA: ACS patients, PCI and CABG patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical TYPE: Numerical value (Originial Version same question and response options as item PRECREATUNIT)

Datentyp

float

Alias
UMLS CUI [1]
C0201976
Indicate units of presenting creatinine level
Beschreibung

INCLUSION CRITERIA: All patients TIMING: At time of diagnosis REPORTING SOURCE: Clinical TYPE: Single Answer

Datentyp

integer

Alias
UMLS CUI [1,1]
C0201976
UMLS CUI [1,2]
C1519795
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Ähnliche Modelle

Baseline Clinical Form

1 Formulare
  1. StudyEvent: ODM
    1. Baseline Clinical Form
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Item Group
Demographic factors
C1704791 (UMLS CUI-1)
Age
Item
What is your date of birth?
date
C0001779 (UMLS CUI [1])
C0421451 (UMLS CUI [2])
Item
Please indicate your sex at birth
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Please indicate your sex at birth
CL Item
Male (1)
C0086582 (UMLS CUI-1)
(Comment:en)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
(Comment:en)
Item Group
Baseline health status
C1442488 (UMLS CUI-1)
C0449440 (UMLS CUI-2)
Item
Indicate if the patient has had at least one documented previous myocardial infarction at any point in their history
integer
C0262926 (UMLS CUI [1,1])
C0027051 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate if the patient has had at least one documented previous myocardial infarction at any point in their history
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient has a documented history of heart failure
integer
C0262926 (UMLS CUI [1,1])
C0018802 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate if the patient has a documented history of heart failure
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient has a documented history of hypertension diagnosed and treated with medication and/or diet and/or exercise
integer
C0262926 (UMLS CUI [1,1])
C0020538 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a documented history of hypertension diagnosed and treated with medication and/or diet and/or exercise
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient has a documented history of stroke
integer
C0262926 (UMLS CUI [1,1])
C0038454 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a documented history of stroke
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents)
integer
C0262926 (UMLS CUI [1,1])
C0011849 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate if the patient has a documented history of diabetes mellitus (regardless of duration of disease or need for anti-diabetic agents)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient is insulin dependent
integer
C0262926 (UMLS CUI [1,1])
C0011854 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate if the patient is insulin dependent
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient has a history of peripheral arterial disease
integer
C1881056 (UMLS CUI [1])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a history of peripheral arterial disease
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient is dialysis dependent
integer
C0524376 (UMLS CUI [1])
Past medical history: Previous AMI
Code List
Indicate whether the patient is dialysis dependent
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Laboratory values: Baseline creatinine level
Item
Indicate the patient’s baseline creatinine level
float
C0201975 (UMLS CUI [1])
Item
Indicate units of baseline creatinine level
integer
C0201975 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate units of baseline creatinine level
CL Item
µmol/l (1)
CL Item
mg/dl (2)
Item
Indicate whether the patient has a chronic lung disease
integer
C1533075 (UMLS CUI [1])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a chronic lung disease
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient is oxygen dependent
integer
C0262926 (UMLS CUI [1,1])
C0030054 (UMLS CUI [1,2])
C0439857 (UMLS CUI [1,3])
Past medical history: Previous AMI
Code List
Indicate if the patient is oxygen dependent
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient has a history of cirrhosis
integer
C0262926 (UMLS CUI [1,1])
C0023890 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a history of cirrhosis
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Item
Indicate whether the patient has a history of dementia
integer
C0262926 (UMLS CUI [1,1])
C0497327 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate whether the patient has a history of dementia
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Laboratory values: Presenting creatinine
Item
Indicate presenting creatinine level
float
C0201976 (UMLS CUI [1])
Item
Indicate units of presenting creatinine level
integer
C0201976 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Past medical history: Previous AMI
Code List
Indicate units of presenting creatinine level
CL Item
µmol/l (1)
C0439300 (UMLS CUI-1)
(Comment:en)
CL Item
mg/dl (2)
C0439271 (UMLS CUI-1)
(Comment:en)
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