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COPD has a profound impact on daily life, yet remains underdiagnosed and undertreated. We set out to develop a brief, reliable, self-scored questionnaire to identify individuals likely to have COPD. COPD-PS TM development began with a list of concepts identified for inclusion using expert opinion from a clinician working group comprised of pulmonologists (n = 5) and primary care clinicians (n = 5). A national survey of 697 patients was conducted at 12 practitioner sites. Logistic regression identified items discriminating between patients with and without fixed airflow obstruction (AO, postbronchodilator FEV 1 /FVC < 70%). ROC analyses evaluated screening accuracy, compared scoring options, and assessed concurrent validity. Convergent and discriminant validity were assessed via COPD-PS and SF-12v2 score correlations. For known-groups validation, COPD-PS differences between clinical groups were tested. Test-retest reliability was evaluated in a 20% sample. Of 697 patients surveyed, 295 patients met expert review criteria for spirometry performance; 38% of these (n = 113) had results indicating AO. Five items positively predicted AO ( p < 0.0001): breathlessness, productive cough, activity limitation, smoking history, and age. COPD-PS scores accurately classified AO status (area under ROC curve = 0.81) and reliable (r = 0.91 MD, MSc, San Jacinto Methodist Hospital, Baytown, TX; Mary Issac, MD, MPH, St. Joseph's Community Care Hospital, Tampa, FL; Fernando J. Martinez, MD, MS, University of Michigan, Ann Arbor, MI; Phillip Menashe, MD, Yakima Chest Clinic, Yakima, WA; Anna W. Parkman, RRT, PhD, Ohio Dominican University, Columbus, OH; Michael A. Russoniello, MD, St. Clares Hospital, Denville, NJ; Frederic D. Seifer, MD, Takoma Adventist Hospital, Greeneville, TN. Correspondence to: Fernando J. Martinez, MD, MS, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI 48109 USA; email: fmartine@umich.edu COPD: Journal of Chronic Obstructive Pulmonary DiseaseApril 2008 85 AO scored significantly higher (6.8, SD = 1.9; p < 0.0001) than patients without AO (4.0, SD = 2.3). Higher scores were associated with more severe AO, bronchodilator use, and overnight hospitalization for breathing problems. With the prevalence of COPD in the studied cohort, a score on the COPD-PS of greater than five was associated with a positive predictive value of 56.8% and negative predictive value of 86.4%. The COPD-PS accurately classified physicianreported COPD (AUC = 0.89). The COPD-PS is a brief, accurate questionnaire that can identify individuals likely to have COPD.

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Efforts to support children in schools require addressing not only academic issues, but also out-of-school factors that can affect students’ ability to succeed. This study examined academic achievement of students participating in City Connects, a student support intervention operating in high-poverty elementary schools. The sample included 7,948 kindergarten to fifth-grade students in a large urban district during 1999–2009. School- and student-level treatment effects on report card grades and standardized test scores in elementary through middle school were estimated. Propensity score methods accounted for pre-intervention group differences. City Connects students demonstrated higher report card scores than comparisons and scored higher on middle school English language arts and mathematics tests. This study provides evidence for the value of addressing out-of-school factors that impact student learning.

Four lessons learned from the project are discussed: the importance of good developmental item banks, the ambiguity of model fit results, the limits of our knowledge regarding the practical implications of model misfit, and the importance in the measurement of HRQOL of construct definition. With respect to these lessons, areas for future research are suggested. The feasibility of developing item banks for broad definitions of health is discussed.

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