Objectives: The specific objectives of this study were: 1. To describe the symptoms reported by patients 30 days prior to admission and at discharge. 2. To determine if there are significant differences between the symptom dimensions of frequency, intensity, and distress. 3. To compare the number of signs and symptoms reported 30 days prior to admission and those reported at discharge. 4. To examine the influence of age, gender, health in general, health now compared to one year ago, quality of life, functional status, and activities of daily living on the number of signs and symptoms reported 30 days prior to admission and at discharge. 5. To examine the influence of age, gender, health in general, health now compared to one year ago, quality of life, functional status, activities of daily living, and total number of symptoms reported 30 days prior to admission and at discharge on patient satisfaction with the quality of nursing care and medical care. 6. To examine the influence of age, gender, health in general, health now compared to one year ago, quality of life, functional status, activities of daily living, and total number of symptoms reported 30 days prior to admission on length of stay. 7. To describe patients’ opinions of the pen-based system as a method of documenting symptoms and the importance of documenting symptoms.
Design: This study used a descriptive, correlational and a comparative within-subjects repeated measures cohort design.
Population, Sample, Setting, Years: The admission sample consisted of 173 patients and the discharge sample included a subsample of 72 patients who were hospitalized on a general medical unit in 1998. The mean age of the sample on admission was 46 and at discharge was 45. Subjects were predominantly Caucasian and gender was almost evenly distributed in both samples.
Concepts or Variables Studied: Symptoms and perceptions of the intensity, duration, and frequency of patient reported symptoms were the primary variables of interest. The relationships between symptoms and age, gender, health in general, health now compared to one year ago, quality of life, functional status, activities of daily living, and patient satisfaction were also examined.
Methods: A Patient Questionnaire was used to collect data on sociodemographic information, computer proficiency, health status, and quality of life. Self-reported symptom data was obtained with the automated Sign and Symptom Checklist. Other measures included the Patient Judgment of Hospital Quality Questionnaire, the End-User Computer Satisfaction Scale, the Karnofsky Performance Status Scale, and the Index of Activities of Daily Living. Chart reviews were conducted to gather diagnostic and length of stay data.
Findings: Patients reported an average of 16 symptoms prior to admission and 8 symptoms at discharge and this decrease was significant. Significant differences were found between symptom frequency and distress dimensions for fatigue, weakness, and skin lesions. Age, gender, quality of life, health in general, health now compared to one year ago, and functional status explained significant variance in the number of symptoms reported prior to admission. Quality of life was the only significant predictor of the number of symptoms reported at discharge. Total number of symptoms at discharge, age, and quality of life explained significant variance in satisfaction with nursing care. The number of symptoms on admission and at discharge, and quality of life were significant predictors of satisfaction with medical care. Race, type of insurance, and independence in activities of daily living were not significant predictors in any of the models. The model for length of stay was not very stable and no significant predictors emerged.
Conclusions: Study findings suggest that hospitalized patients on a general medical unit experience a wide variety of symptoms and patients who experience a number of symptoms have poorer ratings of quality of life. Fatigue, weakness, shortness of breath with activity, gas/bloating, coughing, headache, and nausea were frequently reported at admission and discharge. Findings also suggest that it is feasible to capture self-reported symptom data using a pen-based computer.
Implications: Symptom data may be used by providers and patients in the planning and implementation of interventions aimed at symptom control and for evaluating the effectiveness of symptom management strategies and other treatment strategies. If captured electronically, an instrument which assess common symptoms across medical diagnoses and disease-specific symptoms would provide valuable patient data that has the potential to illuminate the understanding of symptom and illness trajectories.This data could be incorporated in clinical information systems and national health databases and has the potential to improve the clinical care of patients, to enhance health services research, and to improve institutional performance.
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