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dc.contributor.authorGriever, Michelle
dc.contributor.authorSullivan, Frank
dc.contributor.authorKalia, Sumeet
dc.contributor.authorAliarzadeh, Babak
dc.contributor.authorSharma, Deepak
dc.contributor.authorBernard, Steven
dc.contributor.authorMeaney, Christopher
dc.contributor.authorMoineddin, Rahim
dc.contributor.authorEisen, David
dc.contributor.authorRahman, Navid
dc.contributor.authorD'Urzo, Tony
dc.identifier.citationGriever , M , Sullivan , F , Kalia , S , Aliarzadeh , B , Sharma , D , Bernard , S , Meaney , C , Moineddin , R , Eisen , D , Rahman , N & D'Urzo , T 2018 , ' Agreement between hospital and primary care on diagnostic labeling for COPD and heart failure in Toronto, Canada : a cross-sectional observational study ' , npj Primary Care Respiratory Medicine , vol. 28 , 9 .
dc.identifier.otherPURE: 252522281
dc.identifier.otherPURE UUID: 5686a8d8-d2e4-4601-96f5-039ff7097f74
dc.identifier.otherScopus: 85044006497
dc.identifier.otherWOS: 000427441300001
dc.identifier.otherORCID: /0000-0002-6623-4964/work/42734904
dc.descriptionThe authors are grateful to the North York General Foundation for financial support through the Exploration Fund. Dr. Greiver holds an investigator award from the Department of Family and Community Medicine, University of Toronto and was supported by a research stipend from North York General Hospital.en
dc.description.abstractPatients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) are frequently cared for in hospital and in primary care settings. We studied labeling agreement for COPD and HF for patients seen in both settings in Toronto, Canada. This was a retrospective observational study using linked hospital-primary care electronic data from 70 family physicians. Patients were 20 years of age or more and had at least one visit in both settings between 1 January 2012 and 31 December 2014. We recorded labeling concordance and associations with clinical factors. We used capture-recapture models to estimate the size of the populations. COPD concordance was 34%; the odds ratios (ORs) of concordance increased with aging (OR 1.84 for age 75+ vs. <65, 95% CI 0.92–3.69) and more inpatient admissions (OR 2.89 for 3+ visits vs. 0 visits, 95% CI 1.59–5.26). HF concordance was 33%; the ORs of concordance decreased with aging (OR 0.39 for 75+ vs. <65, 95% CI 0.18–0.86) and increased with more admissions (OR = 2.39; 95% CI 1.33–4.30 for 3+ visits vs. 0 visits). Based on capture-recapture models, 21–24% additional patients with COPD and18–20% additional patients with HF did not have a label in either setting. The primary care prevalence was estimated as 748 COPD patients and 834 HF patients per 100,000 enrolled adult patients. Agreement levels for COPD and HF were low and labeling was incomplete. Further research is needed to improve labeling for these conditions.
dc.relation.ispartofnpj Primary Care Respiratory Medicineen
dc.rights© The Author(s) 2018. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectSDG 3 - Good Health and Well-beingen
dc.titleAgreement between hospital and primary care on diagnostic labeling for COPD and heart failure in Toronto, Canada : a cross-sectional observational studyen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Population and Behavioural Science Divisionen
dc.description.statusPeer revieweden

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