title: The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) often experience exacerbations of the disease that require hospitalization. Current guidelines offer little guidance for identifying patients whose clinical situation is appropriate for admission to the hospital, and properly developed and validated severity scores for COPD exacerbations are lacking. To address these important gaps in clinical care, we created the IRYSS-COPD Appropriateness Study.
  
  
  METHODS
  The RAND/UCLA Appropriateness Methodology was used to identify appropriate and inappropriate scenarios for hospital admission for patients experiencing COPD exacerbations. These scenarios were then applied to a prospective cohort of patients attending the emergency departments (ED) of 16 participating hospitals. Information was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up after admission or discharge home. While complete data were generally available at the time of ED admission, data were often missing at the time of decision making. Predefined assumptions were used to impute much of the missing data.
  
  
  CONCLUSIONS
  The IRYSS-COPD Appropriateness Study will validate the appropriateness criteria developed by the RAND/UCLA Appropriateness Methodology and thus better delineate the requirements for admission or discharge of patients experiencing exacerbations of COPD. The study will also provide a better understanding of the determinants of outcomes of COPD exacerbations, and evaluate the equity and variability in access and outcomes in these patients.
authors: Unidad de Investigación, Hospital Galdakao-Usansolo-CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Bizkaia, Spain. josemaria.quintanalopez@osakidetza.net
authors: José M
authors: JM
authors: Quintana
authors: Cristóbal
authors: C
authors: Esteban
authors: Irantzu
authors: I
authors: Barrio
authors: Susana
authors: S
authors: Garcia-Gutierrez
authors: Nerea
authors: N
authors: Gonzalez
authors: Inmaculada
authors: I
authors: Arostegui
authors: Iratxe
authors: I
authors: Lafuente
authors: Marisa
authors: M
authors: Bare
authors: Juan Antonio
authors: JA
authors: Blasco
authors: Silvia
authors: S
authors: Vidal
mesh_terms: D015331:Cohort Studies; D003657:Decision Making; D003697:Delphi Technique; D004636:Emergency Service, Hospital / Q000145:classification*; D006297:Health Services Accessibility / Q000592:standards; D006302:Health Services Research; D006801:Humans; D009313:National Health Programs / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D010820:Physicians / Q000523:psychology; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000628:therapy; D015272:Pulmonary Medicine; D011785:Quality Assurance, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D012959:Socioeconomic Factors; D013030:Spain; D013673:Technology Assessment, Biomedical / Q000379:methods; D016896:Treatment Outcome