The severity of disease affected hospitalization in season 1 also, with the proportion of patients who were hospitalized increasing with the severity of disease: GOLD stage 2, 7 percent; GOLD stage 3, 18 percent; and GOLD stage 4, 33 percent. Factors Associated with Exacerbations In univariate logistic-regression analysis, we assessed factors connected with at least one exacerbation through the initial year of follow-up, using all available baseline assessments in the whole cohort. The very best predictor of an exacerbation in the initial year was a treated exacerbation in the year before study entry .An area opinion leader acted because the facilitator at each site. No economic incentive was provided. The first 6 months of the 1. During the year following the training period, four 3-month audit cycles were implemented by audit committees, with the support of exterior facilitators who made quarterly educational outreach visits. Each cycle included five standardized guidelines: the identification of ladies who acquired cesarean deliveries through the first month of every cycle; the assortment of data, with the use of standardized forms, regarding the administration of labor and delivery; the assessment by the local audit committee, with the use of scientific algorithms, of the relevance of the indications for cesarean delivery; the formulation of tips for guidelines and the evaluation of previous recommendations, both performed by the committee; and the provision of informal and formal opinions to health professionals.