Protocol - Chronic Medical Conditions - Self Reported
Description
A self-report questionnaire which assesses 13 common medical conditions and the impact of comorbidities on functional status.
Specific Instructions
The comorbidity questionnaire is most useful for adults and would not be beneficial for research on pediatric, adolescent and adult patients younger than age 50
Availability
This protocol is freely available; permission not required for use.
Protocol
The following is a list of common problems. Please indicate if you currently have the problem in the first column. If you do not have the problem, skip to next problem.
If you do have the problem, please indicate in the second column if you receive medications or some other type of treatment for the problem.
In the third column indicate if the problem limits any of your activities.
Finally, indicate all medical conditions that are not listed under “other medical problems” at the end of the page.
| Do you have the problem? | Do you receive treatment for it? | Does it limit your activities? | ||||
PROBLEM | No | Yes→ | No | Yes | No | Yes |
Heart disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
High blood pressure | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Lung disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Diabetes | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Ulcer or stomach disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Kidney disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Liver disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Anemia or other blood disease | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Cancer | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Depression | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Osteoarthritis, degenerative arthritis | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Back pain | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Rheumatoid arthritis | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
Other medical problems (please write in) | [ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y |
[ ] N | [ ] Y | [ ] N | [ ] Y | [ ] N | [ ] Y | |
Scoring. An individual can receive a maximum of 3 points for each medical condition: 1 point for the presence of the problem, another point if he/she receives treatment for it, and an additional point if the problem causes a limitation in functioning. Because there are 12 defined medical problems and 3 optional conditions, the maximum score totals 45 points if the open?ended items are used and 36 points if only the close?ended items are used.
Personnel and Training Required
None
Equipment Needs
None
Requirements
| Requirement Category | Required |
|---|---|
| Major equipment | No |
| Specialized training | No |
| Specialized requirements for biospecimen collection | No |
| Average time of greater than 15 minutes in an unaffected individual | No |
Mode of Administration
Self-administered questionnaire
Lifestage
Adult, Senior
Participants
Females ages 50 years and older inpatients from medical and surgical care units. Patients also had to be able to complete the questionnaire in English.
Selection Rationale
This represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.
Language
English
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| caDSR Form | PX320201 Px320201 Chronic Medical Conditions Self Reported | 14328989 | caDSR Form |
Derived Variables
None
Process and Review
Not Applicable
Protocol Name from Source
Self-Administered Comorbidity Questionnaire (SCQ)
Source
Erdem D, Gezer H, Acer Kasman S, Duruoz M. Reliability and Validity of the Self-Administered Comorbidity Questionnaire in Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10).
General References
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003 Apr 15;49(2):156-63. doi: 10.1002/art.10993. PMID: 12687505.
Kates, JM. Treatment-related decisional conflict, quality of life, and comorbidity in older adults with cancer. Asia Pac J Oncol Nurs. 2018 Oct-Dec;5(4):421-429.
Mols F, Oerlemans S, Denollet J, et al. Type D personality is associated with increased comorbidity burden and health care utilization among 3080 cancer survivors. Gen Hosp Psychiatry. 2012 Jul-Aug;34(4):352-9.
Morgans AK, van Bommel ACM, Stowell C, et al. Development of a standardized set of patient-centered outcomes for advanced prostate cancer: an international effort for a unified approach. European Urology. 2015 Nov;68(5):891-8.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum. 2003; 49(2):156-63.
Iezzoni LI, Foley SM, Daley J, Hughes J, Fisher ES, Heeren T. Comorbidities, complications, and coding bias: does the number of diagnosis codes matter in predicting in-hospital mortality. JAMA 1992; 267: 2197–203.
Jencks SF, Williams DK, Kay TL. Assessing hospital-associated deaths from discharge data: the role of length of stay and comorbidities. JAMA 1988; 260: 2240–6
Protocol ID
320201
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX320201_Chronic_Medical_Conditions_Self_Reported_Anemia_Other_Blood_Disease_Problem | ||||
| PX320201080000 | Do you have the problem? Anemia or other more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Back_Pain_Problem | ||||
| PX320201120000 | Do you have the problem? Back pain | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Cancer_Limit_Activities | ||||
| PX320201380000 | Does it limit your activities? Cancer | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Cancer_Treatment | ||||
| PX320201240000 | Do you receive treatment for it? Cancer | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Depression_Problem | ||||
| PX320201100000 | Do you have the problem? Depression | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Diabetes_Problem | ||||
| PX320201040000 | Do you have the problem? Diabetes | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Heart_Disease_Limit_Activities | ||||
| PX320201300000 | Does it limit your activities? Heart disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Heart_Disease_Treatment | ||||
| PX320201160000 | Do you receive treatment for it? Heart disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_High_Blood_Pressure_Problem | ||||
| PX320201020000 | Do you have the problem? High blood pressure | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Kidney_Disease_Problem | ||||
| PX320201060000 | Do you have the problem? Kidney disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Liver_Disease_Limit_Activities | ||||
| PX320201360000 | Does it limit your activities? Liver disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Liver_Disease_Treatment | ||||
| PX320201220000 | Do you receive treatment for it? Liver disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Lung_Disease_Limit_Activities | ||||
| PX320201320000 | Does it limit your activities? Lung disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Lung_Disease_Treatment | ||||
| PX320201180000 | Do you receive treatment for it? Lung disease | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Osteoarthritis_Degenerative_Arthritis_Limit_Activities | ||||
| PX320201400000 | Does it limit your activities? more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Osteoarthritis_Degenerative_Arthritis_Treatment | ||||
| PX320201260000 | Do you receive treatment for it? more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Other_Medical_Problem | ||||
| PX320201140000 | Do you have the problem? Other medical problems | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Rheumatoid_Arthritis_Limit_Activities | ||||
| PX320201420000 | Does it limit your activities? Rheumatoid more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Rheumatoid_Arthritis_Treatment | ||||
| PX320201280000 | Do you receive treatment for it? Rheumatoid more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Ulcer_Stomach_Disease_Limit_Activities | ||||
| PX320201340000 | Does it limit your activities? Ulcer or more | N/A | ||
| PX320201_Chronic_Medical_Conditions_Self_Reported_Ulcer_Stomach_Disease_Treatment | ||||
| PX320201200000 | Do you receive treatment for it? Ulcer or more | N/A | ||
Measure Name
Chronic Medical Conditions - Self Reported
Release Date
December 17, 2020
Definition
The Self-Administered Comorbidity Questionnaire (SCQ) is a self-report which assesses the presence of medical problems, their severity, and whether or not the condition limits activities.
Purpose
A new method to assess comorbidity for clinical and health services research
Keywords
Cancer outcomes and survivorship, comorbidity, chronic medical conditions, cancer patient, conditions, questionnaire, self-administered comorbidity questionnaire (SCQ)
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 320201 | Chronic Medical Conditions - Self Reported |