Chronic Obstructive Pulmonary Disease (COPD) is characterized by airflow limitation that is not fully reversible, usually progressive, and associated with an abnormal pulmonary inflammatory response following the inhalation of noxious particles or gases, particularly cigarette smoke. COPD is one of the leading causes of mortality and morbidity in industrialized countries;it is currently considered the fourth leading cause of death worldwide and is expected to reach third place by 2020. Exacerbations of the disease are associated with increased hospitalizations and mortality.
The “30-day mortality after hospitalization for COPD exacerbation” indicator takes into account short-term mortality in the event of hospitalization for COPD exacerbation and evaluates the outcome from the date of the patient’s hospital admission. The indicator evaluates the functioning of the entire hospital care process starting from the patient’s admission.
Attributing the outcome to the hospital does not imply an assessment of the quality of care provided by that facility, but rather of the appropriateness and effectiveness of the care process that begins with the patient’s arrival at that facility.
Another short-term outcome is “30-day hospital readmissions from treatment for COPD exacerbations,” which can be an indicator of the quality of care and the patient’s in- and out-of-hospital management. The value of the indicators may vary between regional areas and facilities;this phenomenon, in addition to the different quality of care, may be caused by the heterogeneous distribution, due to the case mix, of various risk factors such as age, gender, and the patient’s health. Estimating the number of hospitalizations for COPD allows us to assess the quality of community care for this condition, since adequate out-of-hospital management reduces the onset of complications and consequently the need for hospitalization for these patients.
The “Hospitalization under the standard regime for chronic obstructive pulmonary disease” indicator measures hospitalizations for COPD and does not assess the quality of hospital care, but rather the ability of community care to adequately manage COPD, preventing progression to more severe conditions and the resulting need for hospitalization for exacerbations, respiratory failure, and, in the most severe cases, lung surgery.
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