To measure the effect of the care pathways on the process and outcome indicators, a set of process and outcome indicators to evaluate the effectiveness of in-hospital management of COPD exacerbation was developed based on literature [
24]. Following literature sources were reviewed: (I) the guidelines of Global Initiative for Chronic Obstructive Pulmonary Disease [
20]; (II) the guidelines of the American Thoracic Society-European Respiratory Society Task Force [
32]; (III) an extensive review on management of COPD exacerbation published in 2006 by Rodriguez-Roisin [
33]; (IV) the European Respiratory Monograph, a book on the management of COPD, published by the European Respiratory Society (ERS) in 2006 [
34], (V) The guidelines of the National Institute for Clinical Excellence (NICE) (2004) [
35], (VI) two process flows regarding management of COPD exacerbation in Map of Medicine [
36] and (VII) a systematic review about in-hospital management of COPD exacerbation [
24]. Additionally, three controlled trials about impact of COPD pathways or reviews of COPD and pathways [
26,
27,
37], and 11 COPD outcome studies were reviewed [
28,
29,
39‐
46]. Consent about the final set of indicators was obtained using an international Delphi study ([
18]; Lodewijckx C, Sermeus W, Vanhaecht K, Panella M, Deneckere S, Leigheb F, Troosters T, Decramer M. Selection of indicators for research on COPD care pathways: an international Delphi study. submitted). These indicators were translated in concrete measurements by a multidisciplinary expert panel during a consensus meeting: a medical doctor, a physiotherapist, a clinical nurse specialist and the researchers of the EQCP-study [
18].
To further understand why pathways work, information on the context of the organization is important. Within the EQCP study a set of both generic and COPD specific context indicators and team structure indicators will be developed based on literature review, an international Delphi study and expert opinion [
18].