The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort.
The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort.
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DOI：
10.1186/1472-6963-11-322
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发表时间：
2011-11-24
影响因子：
2.8
通讯作者：
IRYSS-COPD Group
中科院分区：
文献类型：
--
作者：
Quintana JM;Esteban C;Barrio I;Garcia-Gutierrez S;Gonzalez N;Arostegui I;Lafuente I;Bare M;Blasco JA;Vidal S;IRYSS-COPD Group
患有慢性阻塞性肺疾病（COPD）的患者经常经历需要住院治疗的疾病恶化。目前的指南几乎没有提供识别临床情况适合入院的患者的指导，并且缺乏适当开发和验证的COPD急性加重严重程度评分。为了解决临床护理中的这些重要差距，我们创建了IRYSS-COPD适当性研究。使用兰德/加州大学洛杉矶分校的适当方法来确定COPD急性加重患者住院的适当和不适当情况。然后将这些情景应用于16家参与医院急诊科（艾德）的前瞻性患者队列。在患者在艾德接受评价期间、决定患者入院或出院时以及入院或出院后随访期间记录信息。虽然在艾德入院时通常可以获得完整的数据，但在决策时数据往往缺失。使用预定义的假设来估算大部分缺失数据。IRYSS-COPD适当性研究将验证兰德/UCLA适当性方法学制定的适当性标准，从而更好地描述COPD急性加重患者的入院或出院要求。该研究还将更好地了解COPD急性加重结局的决定因素，并评估这些患者的准入和结局的公平性和可变性。
Patients 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. The 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. The 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.
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