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

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Primary care data can effectively risk stratify patients with chronic obstructive pulmonary disease (COPD) using the DOSE index. This approach is feasible even with incomplete electronic health records, aiding proactive COPD management.

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Area of Science:

  • Pulmonary Medicine
  • Health Informatics
  • Clinical Epidemiology

Background:

  • Primary care settings manage most chronic obstructive pulmonary disease (COPD) patient contacts, offering opportunities for proactive management.
  • Electronic health records (EHRs) can facilitate risk stratification but face challenges with data quality and completeness.
  • The DOSE index (Dyspnoea, Obstruction, Smoking, Exacerbation) is a potential tool for COPD risk stratification.

Purpose of the Study:

  • To develop and evaluate a risk stratification algorithm using the DOSE index with routinely collected primary care data.
  • To assess the feasibility and robustness of using primary care data for calculating repeated DOSE index scores over time.
  • To determine the impact of primary care data limitations and linkage to secondary care data on risk stratification accuracy.

Main Methods:

  • Developed a database algorithm to calculate the DOSE index using routinely collected primary care data for diagnosed COPD patients.
  • Calculated up to three risk scores per patient over five years, with at least one-year intervals.
  • Linked primary care data with secondary care data to evaluate under-recording of hospital exacerbations and its impact on risk scores.

Main Results:

  • The algorithm successfully calculated at least one risk score for 77.4% of 10,393 COPD patients; 50.6% had three scores.
  • Primary care data under-recorded hospital exacerbations, causing a slight, non-significant reduction in average risk scores.
  • Less than 1% of patients were misallocated to risk groups due to data limitations, indicating robustness.

Conclusions:

  • Algorithmic calculation of the DOSE index is feasible using primary care data and robust even without secondary care data linkage.
  • The DOSE index offers a practical method for risk stratification in routine primary care for COPD patients.
  • Further research is needed to confirm clinical utility, emphasizing the need for standardized data collection and improved data quality in primary care.