RESULTS: Observed agreement for flagging complications using diagnosis type indicators was generally high between the data sources (agreement ranging from 47 to 97%, and agreement > 80% for 8 of the 12 conditions studied). However, kappa varied greatly across conditions studied (range: -0.06 ± 0.87) and was low at < 0.20 for 6 conditions. Specificity was generally high (range: 68 ± 100%) and was > 90% for 8 conditions, suggesting that pre-existing conditions were usually appropriately coded as such in the administrative data. In contrast, sensitivity was lower (range: 0 ± 83%), with sensitivity < 50% for 7 conditions, indicating a tendency for complications to often be miscoded as baseline comorbidities. CONCLUSION: The validity of diagnosis type indicators in Canadian administrative discharge data appears to be sub-optimal for some types of complications. This is likely to be of greatest concern in studies that rely on diagnosis type indicators to define complications as outcomes. PURPOSE: Recent data suggest that there are substantial variations in the treatment of acute myocardial infarction (AMI) based on age, race, gender and socioeconomic status. Specifically, the use of proven pharmacologic interventions and lifestyle modification counseling have been shown to vary by patient characteristics. We evaluated the use of post-AMI therapies and counseling in patients with AMI treated in an academic referral center with special attention to those receiving medical management alone for AMI. METHODS: We reviewed the records of a convenience sample of 384 patients with AMI from 1997 ± 2000. Our outcomes of interest included use of post-AMI therapies such as aspirin (ASA), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEI) and other anti-coagulants (AC). We collected variables including use of primary angioplasty (PA), defined as a cardiac procedure within twenty-four hours of admission, demographics, comorbidities, do-notresuscitate (DNR) status, physician characteristics, and severity of illness using the ATLAS system. Univariate analyses were performed on the variables of interest, and subsequent logistic regression modeling incorporated all variables significant on univariate analyses. RESULTS: Unadjusted analyses of pharmacologic therapies revealed that severely ill patients were less likely to receive any post-AMI therapies (all p < .05). Older patients were significantly less likely to receive both ASA and BB post-AMI (p < .05), but were not less likely to receive ACEI or AC. Race and gender were not associated with differences in any medication use. Conversely, patients who had undergone PA were significantly more likely to receive all medications (p < .05). Unadjusted analyses of tobacco and cholesterol counseling, defined as any chart reference to tobacco use in current smokers and defined as any chart reference to serum cholesterol in all AMI patients, was significantly more likely to occur if one underwent PA, and significantly less likely to occur as severity of illness increased (p < .05). After adjustment for potential confounders, patients who underwent PA were significantly more likely to receive proven post-AMI therapies and counseling (p < .01), and this increased likelihood persisted across increasing levels of severity of illness. CONCLUSION: Our results indicate significant differences in the use of post-AMI pharmacologic therapies and counseling correlated with the use of primary angioplasty for AMI, despite evidence of proven benefit in AMI in patients undergoing medical management alone. These differences are not explained by severity of illness and suggest that standard therapies may be withheld from those who may benefit most. in the diagnosis and treatment of depression, PCC success in this area is problematic, and direct patient access to mental health care has been proposed as a solution. The purpose of these analyses is to learn how often PCCs in two large healthcare organizations that allow direct patient access to mental health services discuss depression diagnosis or treatment with depressed outpatients, and the relationship between PCC discussion and treatment rates. METHODS: We screened 19,793 consecutive patients attending one of nine primary care practices in one of two staff model managed care organizations in California: three practices based in a single academically-affiliated VA medical center and six in separate Kaiser Permanente (KP) medical centers. Of the 597 who met full criteria for current major depression by diagnostic interview and met other study inclusions criteria, 567 completed a 40-minute telephone-administered survey assessing their mental health care over the preceding six months.