title: Application of appropriateness criteria for hospitalization in COPD exacerbation.
abstract: The IRYSS-COPD appropriateness study was developed in 16 hospitals belonging to the Spanish National Health Service from June 2008 to September 2010 (n = 2,877). The objectives were to apply a set of explicit criteria for the appropriateness of hospital admission created by the RAND/UCLA methodology to patients evaluated in the emergency department (ED) for exacerbations of COPD. This is a prospective cohort study. We explored the relationship between appropriateness of admission as defined by the explicit criteria and the final decision to admit or discharge. A total of 2,877 patients were included for analysis; of these, 1,747 (60.7 %) were admitted and 1,130 (39.3 %) were discharged from the ED to home. Among patients classified by the explicit criteria as appropriate for hospital admission, 81.3 % were admitted, compared with 64.81 % of those classified as uncertain and 48.65 % of those classified as inappropriate for admission. Severity of exacerbation was the most influencing variable in the decision. Application of our explicit criteria for appropriate hospital admission among a large sample of patients experiencing an exacerbation of COPD in the ED setting suggests that these criteria could be used as the basis for clinical decision-making and health-care assessment.
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barrio Labeaga s/n, 48960, Galdakao, Vizcaya, Spain. susana.garciagutierrez@osakidetza.net
authors.forename: Susana
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.forename: José M
authors.initials: JM
authors.lastname: Quintana
authors.forename: Irantzu
authors.initials: I
authors.lastname: Barrio
authors.forename: Marisa
authors.initials: M
authors.lastname: Bare
authors.forename: Nerea
authors.initials: N
authors.lastname: Fernandez
authors.forename: Silvia
authors.initials: S
authors.lastname: Vidal
authors.forename: Nerea
authors.initials: N
authors.lastname: Gonzalez
authors.forename: Iratxe
authors.initials: I
authors.lastname: Lafuente
authors.forename: Edurne
authors.initials: E
authors.lastname: Arteta
authors.forename: Cristóbal
authors.initials: C
authors.lastname: Esteban
authors.forename: Esther
authors.initials: E
authors.lastname: Pulido
mesh_terms: D000368:Aged; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000503:physiopathology*; D012129:Respiratory Function Tests; D013030:Spain / Q000453:epidemiology