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The authors are grateful for the support of the staff members of the different services, research and quality units, as well as the medical records sections of the participating hospitals, and to the patients participating in the study. This work was supported in part by grants from the Fondo de Investigacion Sanitaria (PI061010, PI061017, PI06714, PI060326, PI060664); Department of Health of the Basque Country; and the thematic networks Red IRYSS (Investigacion en Resultados y Servicios Sanitarios) of the Instituto de Salud Carlos III (G03/220).

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Explicit criteria for hospital admission in exacerbations of chronic obstructive pulmonary disease

Publicated to:INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE. 15 (5): 680-686 - 2011-05-01 15(5), DOI: 10.5588/ijtld.10.0408

Authors: Garcia-Gutierrez, S; Quintana, J M; Aguirre, U; Esteban, C; Bilbao, A; Vidal, S; Bare, M; Aizpuru, F; Blasco, J A

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Abstract

OBJECTIVE: To develop detailed, explicit criteria for determining the appropriateness of admission for patients with exacerbations of chronic obstructive pulmonary disease (COPD).DESIGN: Using a modified Delphi process, a panel of seven pneumologists and five emergency department (ED) physicians was assembled to establish the appropriateness of hospital admission for 896 distinct theoretical scenarios. To assess the reliability of the criteria, a second national panel of five pneumologists and five ED physicians was assembled. We examined the influence of all variables on the first panel score using linear regression models. The explicit criteria developed were summarised by classification and regression tree analysis.RESULTS: The appropriateness of the hospitalisation scenarios increased with the severity of COPD. The kappa of agreement between the two panels was 0.79. Predictors of appropriate hospitalisation were severity of current COPD exacerbation, response to previous treatment and expected adherence to treatment. The panel results were synthesised and presented in three decision trees. Misclassification error in the decision trees, as compared with the panel's original ratings, was 6.1%.CONCLUSIONS: These explicit criteria can be used to help determine the appropriateness of admission for patients with exacerbations of COPD.

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