Application of appropriateness criteria for hospitalization in COPD exacerbation

• Published in: Internal and emergency medicine Vol. 8; no. 4; pp. 349 - 357
• Main Authors: Garcia-Gutierrez, Susana, Quintana, José M., Barrio, Irantzu, Bare, Marisa, Fernandez, Nerea, Vidal, Silvia, Gonzalez, Nerea, Lafuente, Iratxe, Arteta, Edurne, Esteban, Cristóbal, Pulido, Esther
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.06.2013; Springer Nature B.V
• Subjects: Aged; CE - Health Technology Assessment; Decision Making; Female; Hospital Mortality; Hospitalization; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Outcome Assessment (Health Care); Prospective Studies; Pulmonary Disease, Chronic Obstructive - mortality; Pulmonary Disease, Chronic Obstructive - physiopathology; Respiratory Function Tests; Spain - epidemiology; Spain; Decision-making; Outcomes assessment; Acute; Conditions
• ISSN: 1828-0447; 1970-9366
• DOI: 10.1007/s11739-013-0927-9

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.