crf2a_version |
|
radio |
CRF2 Version Completed |
1, Unversioned ; 2, 1.0 ; 3, 1.1 ; 4, 1.2 ; 5, 1.3 ; 6, 1.4 ; 7, 1.5 ; 8, 2.0 |
crf2a_date |
|
text |
Date of consultation |
|
crf2a_consulting_clinician |
|
text |
Consulting clinician |
|
crf2a_consultation_method |
|
radio |
Consultation Method |
1, Telephone Consultation ; 2, Face to face consultation |
crf2a_not_completed |
|
yesno |
Unable to complete? |
1, Yes ; 0, No |
crf2a_reason_not_done |
|
radio |
Reason unable to complete |
1, Language ; 2, Declined ; 3, Died ; 4, No answer ; 5, Other |
crf2a_not_done_other |
|
notes |
Other(specify): |
|
crf2a_age |
Patient details |
text |
Age |
|
crf2a_sex |
|
radio |
Sex at birth |
1, Male ; 2, Female |
crf2a_date_discharged |
|
text |
Date discharged from hospital |
|
crf2a_lives_with |
|
text |
Lives with |
|
crf2a_pre_con_pulm |
Pre-existing conditions (prior to hospitalisation for COVID19) |
radio |
Pulmonary |
1, Yes ; 2, No |
crf2a_pre_con_card |
|
radio |
Cardiovascular |
1, Yes ; 2, No |
crf2a_pre_con_diab |
|
radio |
Diabetes |
1, Yes ; 2, No |
crf2a_pre_con_hypt |
|
radio |
Hypertension |
1, Yes ; 2, No |
crf2a_pre_con_other |
|
radio |
Other |
1, Yes ; 2, No |
crf2a_pre_con_other_detail |
|
notes |
Other (Specify) |
|
crf2a_consent |
Introduction and consent |
yesno |
Patient consent to telephone triage |
1, Yes ; 0, No |
crf2a_sta_newmed |
Status since discharge |
radio |
a) Have you had any new medical problems? |
1, Yes ; 0, No |
crf2a_sta_readm |
|
radio |
b) Have you needed readmission to hospital since your discharge? |
1, Yes ; 0, No |
crf2a_sta_other |
|
radio |
c) Have you used any other health services since discharge (e.g. your GP?) |
1, Yes ; 0, No |
crf2a_sta_newmed_detail |
|
notes |
New medical problems details: |
|
crf2a_sta_other_detail |
|
notes |
Other health services details: |
|
crf2a_recovered |
|
radio |
d) Do you feel fully recovered from COVID19 |
1, Yes ; 2, No ; 3, Unsure |
crf2a_eq5d5l_done |
Activity and Self Care Assessment |
yesno |
a) Have you completed a EQ-5D-5L form? |
1, Yes ; 0, No |
crf2a_gppaq_done |
|
yesno |
b) Have you completed a General Practice Physical Activity Questionnaire form? |
1, Yes ; 0, No |
crf2a_sarcf_done |
|
yesno |
c) Have you completed a SARC-F Questionnaire form? |
1, Yes ; 0, No |
crf2a_mrc_done |
|
yesno |
d) Have you completed MRC Dyspnoea Scale form? |
1, Yes ; 0, No |
crf2a_rcfs_done |
|
yesno |
e) Have you completed a Rockwood Clinical Frailty Scale form? |
1, Yes ; 0, No |
crf2a_health_problem_done |
|
yesno |
Have you completed Health Problems form (part of the Patient Symptom Questionnaire)? |
1, Yes ; 0, No |
crf2a_mental_done |
Mental Health Assessment |
yesno |
Have you completed a Mental Health Assessment form? |
1, Yes ; 0, No |
crf2a_nutrition_done |
Nutrition |
yesno |
Have you completed a Nutrition form? |
1, Yes ; 0, No |
crf2a_new_problems |
|
yesno |
10. Are you experiencing any new problems that we haven't mentioned? |
1, Yes ; 0, No |
crf2a_new_problems_detail |
|
notes |
New problems experienced |
|
crf2a_info_at_discharge |
|
notes |
11. What information would have been helpful to receive at discharge? |
|
crf2a_checklist_ai |
Signposting checklist |
radio |
i) https://www.nhs.uk/live-well/ |
1, Yes ; 0, No |
crf2a_checklist_aii |
|
radio |
ii) Improving Access to Psychological Therapies (IAPT) |
1, Yes ; 0, No |
crf2a_checklist_aiii |
|
radio |
iii) Sleep hygiene https://w ww.nhs.uk/live-well/sleep-and-tiredness/ |
1, Yes ; 0, No |
crf2a_checklist_aiv |
|
radio |
iv) Mental wellbeing - Daylight app/weblink https://www.nhs.uk/conditions/stress-anxiety-depression/improve-mental- wellbeing/ |
1, Yes ; 0, No |
crf2a_checklist_av |
|
radio |
v) Alcohol - 'Drink free days' https://www.nhs.uk/oneyou/apps/ |
1, Yes ; 0, No |
crf2a_checklist_avi |
|
radio |
vi) Physical inactivity - 'couch to 5K' or 'Active 10' https://www.nhs.uk/live-well/exercise/ |
1, Yes ; 0, No |
crf2a_checklist_avii1 |
|
radio |
vii) Smoking: Advice https://www.nhs.uk/live-well/quit-smoking/ |
1, Yes ; 0, No |
crf2a_checklist_avii2 |
|
radio |
vii) Smoking cessation referral |
1, Yes ; 0, No |
crf2a_checklist_avii3 |
|
radio |
vii) 'Smoke free' app |
1, Yes ; 0, No |
crf2a_checklist_aviii |
|
radio |
viii) Weight management: http://www.nhs.uk/live-well/healthyweight/start-the-nhs-weight-loss-plan/ |
1, Yes ; 0, No |
crf2a_checklist_aix |
|
radio |
ix) Healthy eating - add local links https://www.nhs.uk/live-well/eat-well/ |
1, Yes ; 0, No |
crf2a_checklist_ax |
|
radio |
x) Rehabilitation services - add local links |
1, Yes ; 0, No |
crf2a_checklist_axi |
|
radio |
xi) Social prescribing |
1, Yes ; 0, No |
crf2a_checklist_b |
|
yesno |
13.b) Follow locally agreed pathway where symptoms/ problems identified above (particularly progressive breathlessness) |
1, Yes ; 0, No |
crf2a_checklist_c |
|
yesno |
13.c) Send CXR request if no face to face follow up, and arrange review |
1, Yes ; 0, No |
crf2a_checklist_d |
|
yesno |
13.d) Discuss sending research PIS - Does the participant consent to being contacted about future research? |
1, Yes ; 0, No |