APPENDIX – online only

1) Cohort selection

Inclusion criteria:

All 26.730 acute episodes of carein the period 1-1-2001/30-9-2005 for 35+ year-aged residents in Rome with acute exacerbation of COPD

- main diagnosis of COPD – ICD-9-CM codes 490, 491, 492, 494, 496

- main diagnosis of acute respiratory failure (ICD-9-CM codes 518.81 or 518.82) or dyspnoea - other respiratory symptoms (ICD-9-CM codes 786.0, 786.2, 786.4) and secondary diagnosis of COPD.

Exclusion criteria:

- secondary diagnosis of major trauma (ICD-9-CM=484-487) or major surgical operations during the index event (surgical DRG excluding 482 and 483) (n=160)

- multiple episodes in a 90-day period preceding the index episode of care (n=3188)

- double records / problems in record linkage / missing area-based SEP index (n= 3252)

- routine admissions(non-emergency) (n=7.374)

At the end of the selection procedures, a total of 12.756 episodes of care were selected corresponding to 10.124 patients.

2) Clinical variables – ICD-9-CM codes used for cohort selection and for risk adjustment

Both for cohort selection and for risk adjustment

Acute respiratory failure / 518.81, 518.82
Dispnoea and other respiratory symptoms / 786.0

Only for risk adjustment

Acute respiratory conditions including infections (empyema, pneumothorax, pleuritis, collapse, abscess, acute bronchitis, pneumonia and other pulmonary infections) / 510, 511, 512, 513
518.0, 415, 466, 480-487-0
011, 012.0, 012.1, 012.2. 012.8

3) Comorbidity – ICD-9-CM codes – different algorithms for the index event and previous 4-year hospitalizations

Comorbidity / Codes for Index admissions / Codes for previous 4-year admissions
Diabetes / 250.0 250.4-250.7, 250.9 / 250.0-250.9
Hypertension / 401- 405 / 401-405
Ischemic heart disease / 412, 414 / 410-414, 429.7
Heart failure / Cor polmonare / 428, 416.9 / 428, 416.9
Other chronic heart disease / 394-397.1, 424, 746.3-746.6, V42.2, V43.3, 393, 397.9, 398, 423 (excluding 423.0), 425, 745, V15.1, V42.2, V43.2, V45.0, V45.81
V45.82 / 429 (excluding 429.7)
093.2, 394-397.1, 424, 746.3-746.6, V42.2, V43.3, 393, 397.9, 398, 423, 391, 420, 421, 422, 425, 745, V15.1, V42.2, V43.2, V45.0, V45.81, V45.82
procedures: 36.1, 36.0,
35, 37.0, 37.1, 37.3, 37.4, 37.5, 37.6, 37.9
Arrhytmia / 426.0, 426.10, 426.12, 426.13, 426.7, 426.9, 427 (excluding 427.1, 427.2, 427.5), 785.0, V45.0, V53.3 / 426.0, 426.10, 426.12, 426.13, 426.7, 426.9, 427, 785.0, 996.01, 996.04, V45.0, V53.3
Vascular peripheral disease including cerebrovascular / 433, 437, 438
440-448 (excluding 441.1, 441.3, 441.5, 441.6, 444), 557.1, 093.0 / 430-438
procedures 38.01, 38.02, 38.11, 38.12, 38.31, 38.32, 38.41, 38.42, 38.61, 38.62, 38.81, 38.82
440-448, 557, 093.0
procedures 38.08, 38.18, 38.38, 38.48, 38.68, 38.88, 39.29
procedures 38.04-38.07, 38.14-38.16, 38.34-38.37, 38.44-38.47, 38.55, 38.57, 38.64-38.67, 38.7, 38.84-38.87, 30.0, 39.1, 39.21-39.26, 39.52, 39.54
Obesity and lipid metabolism disorders / 278.0, 272 / 278.0, 272
Chronic digestive disease / 456.0- 456.2, 571-572 (excluding 571.1, 572.0- 572.2), 573.0, V42.7
577.1-577.9, 555, 556 / 0.70, 456.0- 456.2, 570, 571-572 (excluding 571.1), 573, 573.0, V42.7
577.0-577.9, 555, 556
Chronic Renal Disease / 582-583, 585-588, V42.0, V45.1, V56
procedures 38.95, 39.95, 54.98 / 582-588, V42.0, V45.1, V56
procedures 38.95, 39.95, 54.98, 55.6
Neurological and muscolar disease / 334.1, 342, 343, 344,
331, 332, 332.1, 333.4, 333.5, 334-335, 336.2, 340, 341, 345, 348.1, 348.3, 784.3, 356, 358, 359 / 334.1, 342, 343, 344,
331, 332, 333.4, 333.5, 334-335, 336.2, 340, 341, 345, 348.1, 348.3, 784.3, 356-359
Anemia and coagulation disorders / 280, 281, 285.9
286, 287.1, 287.3-287.5 / 280, 281, 285.9
286, 287.1, 287.3-287.5
Thyroid Disease / 240-241, 243-245 (excluding 245.0 e 245.1), 246 / 240-246
Psychiatric Disease / 293.8, 295-298, 299.1
290.0-290.4, 294.1, 331.0
300.4, 301.12, 309.0, 309.1, 311 / 293.8, 295-298, 299.1
290.0-290.4, 294.1, 331.0
300.4, 301.12, 309.0, 309.1, 311
Chronic Respiratory Disease other than COPD / 493
515, 516
500-505
135, 506-508, 495, 135, 517, 519, 518.1-518.3, 518.89 / 493
515, 516
500-505
135, 506-508, 495, 135, 517, 519, 518.1-518.3, 518.89
Cancer / 140.0–208.9, V10
162, 163 / 140.0–208.9, V10
162, 163

4) List of participating hospitals

(alphabetic order)

Aurelia Hospital, Roma

Azienda Ospedaliera Complesso Ospedaliero San Giovanni – Addolorata, Roma

Azienda Ospedaliera San Camillo Forlanini, Roma

Azienda Policlinico Umberto I, Roma

Casa di cura Life Hospital, Roma

Casa di cura San Giorgio, Roma

Casa di cura Valle Fiorita, Roma

Complesso Integrato Columbus – UCSC, Roma

Istituto Figlie Di S. Camillo Ospedale Vannini, Roma

Ospedale Cristo Re, Roma

Ospedale Generale Santo Spirito, Roma

Ospedale Grassi, Ostia (Roma)

Ospedale San Carlo di Nancy, Roma

Ospedale Sant’Eugenio, Roma

Ospedale San Filippo Neri, Roma

Ospedale San Giacomo, Roma

Ospedale San Pietro – Fatebenefratelli, Roma

Ospedale San Sebastiano Martire, Frascati (Roma)

Ospedale Sandro Pertini, Roma

Policlinico Casilino, Roma

Policlinico Universitario Agostino Gemelli, Roma