The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohortReport as inadecuate

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BMC Health Services Research

, 11:322

First Online: 24 November 2011Received: 13 July 2011Accepted: 24 November 2011DOI: 10.1186-1472-6963-11-322

Cite this article as: Quintana, J.M., Esteban, C., Barrio, I. et al. BMC Health Serv Res 2011 11: 322. doi:10.1186-1472-6963-11-322


BackgroundPatients 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-DesignThe 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.

DiscussionThe 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.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-11-322 contains supplementary material, which is available to authorized users.

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Author: José M Quintana - Cristóbal Esteban - Irantzu Barrio - Susana Garcia-Gutierrez - Nerea Gonzalez - Inmaculada Arostegui -


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