• Susana Garcia-Gutierrez, José M Quintana, Irantzu Barrio, Marisa Bare, Nerea Fernandez, Silvia Vidal, Nerea Gonzalez, Iratxe Lafuente, Edurne Arteta, Cristóbal Esteban, Esther Pulido, and IRYSS-COPD Appropriateness Study (IRYSS-CAS) group.
• 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
• Intern Emerg Med. 2013 Jun 1; 8 (4): 349-57.

AbstractThe 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.

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