Agreement between primary care and hospital diagnosis of schizophrenia and bipolar disorder: A cross-sectional, observational study using record linkage

PLoS One. 2019 Jan 7;14(1):e0210214. doi: 10.1371/journal.pone.0210214. eCollection 2019.


People with serious mental illness die 10-25 years sooner than people without these conditions. Multiple challenges to accessing and benefitting from healthcare have been identified amongst this population, including a lack of coordination between mental health services and general health services. It has been identified in other conditions such as diabetes that accurate documentation of diagnosis in the primary care chart is associated with better quality of care. It is suspected that if a patient admitted to the hospital with serious mental illness is then discharged without adequate identification of their diagnosis in the primary care setting, follow up (such as medication management and care coordination) may be more difficult. We identified cohorts of patients with schizophrenia and bipolar disorder who accessed care through the North York Family Health Team (a group of 77 family physicians in Toronto, Canada) and North York General Hospital (a large community hospital) between January 1, 2012 and December 31, 2014. We identified whether labeling for these conditions was concordant between the two settings and explored predictors of concordant labeling. This was a retrospective cross-sectional study using de-identified data from the Health Databank Collaborative, a linked primary care-hospital database. We identified 168 patients with schizophrenia and 370 patients with bipolar disorder. Overall diagnostic concordance between primary care and hospital records was 23.2% for schizophrenia and 15.7% for bipolar disorder. Concordance was higher for those with multiple (2+) inpatient visits (for schizophrenia: OR 2.42; 95% CI 0.64-9.20 and for bipolar disorder: OR 8.38; 95% CI 3.16-22.22). Capture-recapture modeling estimated that 37.4% of patients with schizophrenia (95% CI 20.7-54.1) and 39.6% with bipolar disorder (95% CI 25.7-53.6) had missing labels in both settings when adjusting for patients' age, sex, income quintiles and co-morbidities. In this sample of patients accessing care at a large family health team and community hospital, concordance of diagnostic information about serious mental illness was low. Interventions should be developed to improve diagnosis and continuity of care across multiple settings.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / therapy
  • Continuity of Patient Care / statistics & numerical data
  • Cross-Sectional Studies
  • Electronic Health Records / statistics & numerical data
  • Female
  • Hospital Records / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Patient Discharge / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Retrospective Studies
  • Schizophrenia / diagnosis*
  • Schizophrenia / therapy
  • Young Adult

Grant support

Support for this project was provided by North York General Hospital. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.