Open Access Study protocol

The IRYSS-COPD appropriateness study: objectives, methodology, and description of the prospective cohort

José M Quintana17*, Cristóbal Esteban2, Irantzu Barrio13, Susana Garcia-Gutierrez1, Nerea Gonzalez1, Inmaculada Arostegui3, Iratxe Lafuente1, Marisa Bare4, Juan Antonio Blasco5, Silvia Vidal6 and the IRYSS-COPD group

Author Affiliations

1 Unidad de Investigación, Hospital Galdakao-Usansolo - CIBER Epidemiología y Salud Pública (CIBERESP), Galdakao, Bizkaia, Spain

2 Servicio de Respiratorio, Hospital Galdakao-Usansolo, Galdakao, Spain

3 Departamento de Matemática Aplicada, Estadística e Investigación Operativa- CIBER Epidemiología y Salud Pública (CIBERESP), Universidad del País Vasco, Lejona, Bizkaia, Spain

4 Unidad de Epidemiología Clínica, Corporacio Parc Tauli, Barcelona, Spain

5 Agencia Lain Entralgo, Madrid, Spain

6 Unidad de Calidad, Hospital Valme, Sevilla, Spain

7 Departamento de Medicina Preventiva y Salud Pública, Universidad del País Vasco, Lejona, Bizkaia, Spain

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BMC Health Services Research 2011, 11:322  doi:10.1186/1472-6963-11-322

Published: 24 November 2011



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.