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Primary care risk stratification in COPD using routinely collected data: a secondary data analysis

Primary care risk stratification in COPD using routinely collected data: a secondary data analysis
Primary care risk stratification in COPD using routinely collected data: a secondary data analysis
Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores
for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.
2055-1010
Johnson, Matthew James
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Rigge, Lucy
549478f7-ac05-4164-8150-f657c88e7110
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Josephs, Lynn
865f1878-f0ca-42c3-a030-df6dcbc705b0
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wilkinson, Thomas
8c55ebbb-e547-445c-95a1-c8bed02dd652
Johnson, Matthew James
d272ca76-f017-4457-96f5-daf6a7af6adf
Rigge, Lucy
549478f7-ac05-4164-8150-f657c88e7110
Culliford, David
25511573-74d3-422a-b0ee-dfe60f80df87
Josephs, Lynn
865f1878-f0ca-42c3-a030-df6dcbc705b0
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wilkinson, Thomas
8c55ebbb-e547-445c-95a1-c8bed02dd652

Johnson, Matthew James, Rigge, Lucy, Culliford, David, Josephs, Lynn, Thomas, Mike and Wilkinson, Thomas (2019) Primary care risk stratification in COPD using routinely collected data: a secondary data analysis. NPJ primary care respiratory medicine, 2019, [42]. (doi:10.1038/s41533-019-0154-6).

Record type: Article

Abstract

Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. Among 10,393 patients with diagnosed COPD, sufficient primary care data were present to calculate at least one risk score for 77.4%, and the maximum of three risk scores
for 50.6%. Linked secondary care data revealed primary care under-recording of hospital exacerbations, which translated to a slight, non-significant cohort average risk score reduction, and an understated risk group allocation for less than 1% of patients. Algorithmic calculation of the DOSE index is possible using primary care data, and appears robust to the absence of linked secondary care data, if unavailable. The DOSE index appears a simple and practical means of incorporating risk stratification into the routine primary care of COPD patients, but further research is needed to evaluate its clinical utility in this setting. Although secondary analysis of routinely collected primary care data could benefit clinicians, patients and the health system, standardised data collection and improved data quality and completeness are also needed.

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Accepted/In Press date: 8 November 2019
Published date: 4 December 2019

Identifiers

Local EPrints ID: 436414
URI: http://eprints.soton.ac.uk/id/eprint/436414
ISSN: 2055-1010
PURE UUID: 0cd701b6-b8d9-47d0-b2e1-8c3ad56ea0fd
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253

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Date deposited: 10 Dec 2019 17:30
Last modified: 26 Nov 2021 02:48

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Contributors

Author: Matthew James Johnson
Author: Lucy Rigge
Author: David Culliford ORCID iD
Author: Lynn Josephs
Author: Mike Thomas

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