Matthew B Stanbrook

University of Toronto, Toronto, Ontario, Canada

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Publications (131)1032.4 Total impact

  • Matthew B. Stanbrook

    No preview · Article · Dec 2015 · Annals of internal medicine
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    Full-text · Article · Dec 2015 · Canadian Medical Association Journal
  • Matthew B Stanbrook

    No preview · Article · Sep 2015 · Annals of internal medicine
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    ABSTRACT: Disparities in COPD health outcomes have been found with older individuals, men and those of lower socioeconomic status doing worse. We sought to determine if this was due to differences in access to COPD medications. We conducted a retrospective cohort study using population health administrative data from Ontario, Canada, a province with universal prescription drug coverage for older adults. All individuals with COPD aged 67 years and older in 2008 who were not taking inhaled long-acting bronchodilators or inhaled corticosteroids were followed for 2 years. Poisson regression was used to determine the effects of age, sex, and socioeconomic status on the likelihood of initiating one of these medications, after adjusting for potential confounders. Over the study period, 54,050 of 185,698 (29.1%) older individuals with COPD not previously taking any inhaled long-acting bronchodilators or corticosteroids were initiated on one or more of these medications. After adjustment, individuals of low socioeconomic status, measured using neighborhood income level quintiles, were slightly more likely to initiate COPD medications than those of high socioeconomic status (relative risk (RR) 1.05; 95% confidence interval (95% CI) 1.02-1.08). While men received COPD medication at a consistent rate across all age groups, the likelihood that a woman received medication decreased with increasing age. With the exception of older women, there was minimal disparity in prescription for COPD medications. Disparity in health outcomes among Ontario COPD patients is not clearly explained by differences in medication access by socioeconomic status, sex or age.
    No preview · Article · Aug 2015 · COPD Journal of Chronic Obstructive Pulmonary Disease
  • Matthew B Stanbrook

    No preview · Article · Mar 2015 · Annals of internal medicine
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    ABSTRACT: Previous research has shown variations in quality of care and patient outcomes under different primary care models. The objective of this study was to use previously validated, evidence-based performance indicators to measure quality of asthma care over time and to compare quality of care between different primary care models. Data were obtained for years 2006 to 2010 from the Ontario Asthma Surveillance Information System, which uses health administrative databases to track individuals with asthma living in the province of Ontario, Canada. Individuals with asthma (n=1,813,922) were divided into groups based on the practice model of their primary care provider (i.e., fee-for-service, blended fee-for-service, blended capitation). Quality of asthma care was measured using six validated, evidence-based asthma care performance indicators. All of the asthma performance indicators improved over time within each of the primary care models. Compared to the traditional fee-for-service model, the blended fee-for-service and blended capitation models had higher use of spirometry for asthma diagnosis and monitoring, higher rates of inhaled corticosteroid prescription, and lower outpatient claims. Emergency department visits were lowest in the blended fee-for-service group. Quality of asthma care improved over time within each of the primary care models. However, the amount by which they improved differed between the models. The newer primary care models (i.e., blended fee-for-service, blended capitation) appear to provide better quality of asthma care compared to the traditional fee-for-service model.
    Full-text · Article · Feb 2015 · BMC Family Practice
  • Andrea S Gershon · Michael A Campitelli · Matthew B Stanbrook

    No preview · Article · Jan 2015 · JAMA The Journal of the American Medical Association
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    Lisa Richardson · Matthew B Stanbrook

    Preview · Article · Jan 2015 · Canadian Medical Association Journal
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    ABSTRACT: Importance Chronic obstructive pulmonary disease (COPD), a manageable respiratory condition, is the third leading cause of death worldwide. Knowing which prescription medications are the most effective in improving health outcomes for people with COPD is essential to maximizing health outcomes.Objective To estimate the long-term benefits of combination long-acting β-agonists (LABAs) and inhaled corticosteroids compared with LABAs alone in a real-world setting.Design, Setting, and Patients Population-based, longitudinal cohort study conducted in Ontario, Canada, from 2003 to 2011. All individuals aged 66 years or older who met a validated case definition of COPD on the basis of health administrative data were included. After propensity score matching, there were 8712 new users of LABA–inhaled corticosteroid combination therapy and 3160 new users of LABAs alone who were followed up for median times of 2.7 years and 2.5 years, respectively.Exposures Newly prescribed combination LABAs and inhaled corticosteroids or LABAs alone.Main Outcomes and Measures Composite outcome of death and COPD hospitalization.Results The main outcome was observed among 5594 new users of LABAs and inhaled corticosteroids (3174 deaths [36.4%]; 2420 COPD hospitalizations [27.8%]) and 2129 new users of LABAs alone (1179 deaths [37.3%]; 950 COPD hospitalizations [30.1%]). New use of LABAs and inhaled corticosteroids was associated with a modestly reduced risk of death or COPD hospitalization compared with new use of LABAs alone (difference in composite outcome at 5 years, −3.7%; 95% CI, −5.7% to −1.7%; hazard ratio [HR], 0.92; 95% CI, 0.88-0.96). The greatest difference was among COPD patients with a codiagnosis of asthma (difference in composite at 5 years, −6.5%; 95% CI, −10.3% to −2.7%; HR, 0.84; 95% CI, 0.77-0.91) and those who were not receiving inhaled long-acting anticholinergic medication (difference in composite at 5 years, −8.4%; 95% CI, −11.9% to −4.9%; HR, 0.79; 95% CI, 0.73-0.86).Conclusions and Relevance Among older adults with COPD, particularly those with asthma and those not receiving a long-acting anticholinergic medication, newly prescribed LABA and inhaled corticosteroid combination therapy, compared with newly prescribed LABAs alone, was associated with a significantly lower risk of the composite outcome of death or COPD hospitalization.
    No preview · Article · Sep 2014 · JAMA The Journal of the American Medical Association
  • Matthew B Stanbrook

    No preview · Article · Aug 2014 · Annals of internal medicine
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    ABSTRACT: Importance Thoracentesis is performed to identify the cause of a pleural effusion. Although generally safe, thoracentesis may be complicated by transient hypoxemia, bleeding, patient discomfort, reexpansion pulmonary edema, and pneumothorax.Objective To identify the best means for differentiating between transudative and exudative effusions and also to identify thoracentesis techniques for minimizing the risk of complications by performing a systematic review the evidence.Data Sources We searched The Cochrane Library, MEDLINE, and Embase from inception to February 2014 to identify relevant studies.Study Selection We included randomized and observational studies of adult patients undergoing thoracentesis that examined diagnostic tests for differentiating exudates from transudates and evaluated thoracentesis techniques associated with a successful procedure with minimal complications.Data Extraction and Synthesis Two investigators independently appraised study quality and extracted data from studies of laboratory diagnosis of pleural effusion for calculation of likelihood ratios (LRs; n = 48 studies) and factors affecting adverse event rates (n = 37 studies).Results The diagnosis of an exudate was most accurate if cholesterol in the pleural fluid was greater than 55 mg/dL (LR range, 7.1-250), lactate dehydrogenase (LDH) was greater than 200 U/L (LR, 18; 95% CI, 6.8-46), or the ratio of pleural fluid cholesterol to serum cholesterol was greater than 0.3 (LR, 14; 95% CI, 5.5-38). A diagnosis of exudate was less likely when all Light’s criteria (a ratio of pleural fluid protein to serum protein >0.5, a ratio of pleural fluid LDH to serum LDH >0.6, or pleural fluid LDH >two-thirds the upper limit of normal for serum LDH) were absent (LR, 0.04; 95% CI, 0.02-0.11). The most common complication of thoracentesis was pneumothorax, which occurred in 6.0% of cases (95% CI, 4.0%-7.0%). Chest tube placement was required in 2.0% of procedures (95% CI, 0.99%-2.9%) in which a patient was determined to have radiographic evidence of a pneumothorax. With ultrasound, a radiologist’s marking the needle insertion site was not associated with decreased pneumothorax events (skin marking vs no skin marking odds ratio [OR], 0.37; 95% CI, 0.08-1.7). Use of ultrasound by any experienced practitioner also was not associated with decreased pneumothorax events (OR, 0.55; 95% CI, 0.06-5.3).Conclusions and Relevance Light’s criteria, cholesterol and pleural fluid LDH levels, and the pleural fluid cholesterol-to-serum ratio are the most accurate diagnostic indicators for pleural exudates. Ultrasound skin marking by a radiologist or ultrasound-guided thoracentesis were not associated with a decrease in pneumothorax events.
    Full-text · Article · Jun 2014 · JAMA The Journal of the American Medical Association
  • Matthew B Stanbrook · Michael Campitelli · Andrea Gershon

    No preview · Article · Apr 2014 · JAMA Internal Medicine
  • Matthew B Stanbrook

    No preview · Article · Oct 2013 · Annals of internal medicine
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    Kirsten Patrick · Matthew Stanbrook · Ken Flegel

    Full-text · Article · Sep 2013 · Canadian Medical Association Journal
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    ABSTRACT: Importance Chronic obstructive pulmonary disease (COPD) is a common and deadly disease. Long-acting inhaled β-agonists and anticholinergics, first-line medications for COPD, have been associated with increased risk of cardiovascular outcomes. When choosing between the medications, patients and physicians would benefit from knowing which has the least risk.Objective To assess the association of these classes of medications with the risk of hospitalizations and emergency department visits for cardiovascular events.Design We conducted a nested case-control analysis of a retrospective cohort study. We compared the risk of events between patients newly prescribed inhaled long-acting β-agonists and anticholinergics, after matching and adjusting for prognostic factors. Setting Health care databases from Ontario, the largest province of Canada, with a multicultural population of approximately 13 million.Participants All individuals 66 years or older meeting a validated case definition of COPD, based on health administrative data, and treated for COPD from September 1, 2003, through March 31, 2009. Exposure New use of an inhaled long-acting β-agonist or long-acting anticholinergic.Main Outcome and Measures An emergency department visit or a hospitalization for a cardiovascular event. Results Of 191 005 eligible patients, 53 532 (28.0%) had a hospitalization or an emergency department visit for a cardiovascular event. Newly prescribed long-acting inhaled β-agonists and anticholinergics were associated with a higher risk of an event compared with nonuse of those medications (respective adjusted odds ratios, 1.31 [95% CI, 1.12-1.52; P < .001] and 1.14 [1.01-1.28; P = .03]). We found no significant difference in events between the 2 medications (adjusted odds ratio of long-acting inhaled β-agonists compared with anticholinergics, 1.15 [95% CI, 0.95-1.38; P = .16]).Conclusions and Relevance Among older individuals with COPD, new use of long-acting β-agonists and anticholinergics is associated with similar increased risks of cardiovascular events. Close monitoring of COPD patients requiring long-acting bronchodilators is needed regardless of drug class.
    No preview · Article · May 2013 · JAMA Internal Medicine
  • Matthew B Stanbrook
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    ABSTRACT: QUESTION Is biomarker- or symptom-based adjustment of inhaled corticosteroid (ICS) dose better than physician assessment-based adjustment for preventing treatment failure in adults with mild to moderate asthma? METHODS DESIGN Randomized, placebo-controlled, 3-group trial (Best Adjustment Strategy for Asthma in the Long Term [BASALT] trial). NCT00495157. ALLOCATION Unclear allocation concealment.* BLINDING Blinded* (patients). FOLLOW-UP PERIOD 36 weeks. SETTING 10 academic medical centers in the USA. PATIENTS 342 adults (mean age 35 y, 69% women) who had physician-diagnosed, mild to moderate, persistent asthma that was well- or partially controlled with low-dose ICSs; reversible airflow limitation or airway hyperresponsiveness; and ≥ 75% treatment adherence between enrollment and randomization. INTERVENTIONS Beclomethasone HFA inhaler, twice daily, with dose adjusted every 6 weeks based on exhaled nitric oxide levels, plus 2 placebo inhalers (1 used twice daily and 1 as needed) (biomarker group, n = 115); beclomethasone inhaler used only when rescue albuterol was used, plus 2 placebo inhalers used twice daily (symptom group, n = 113); or beclomethasone inhaler, twice daily, with dose adjusted every 6 weeks based on guideline-informed physician assessment, plus 2 placebo inhalers (1 used twice daily and 1 as needed) (physician group, n = 114). All groups used an albuterol inhaler as needed for asthma symptoms. OUTCOMES Primary outcome was first treatment failure (clinically important worsening of asthma). Other outcomes included exacerbations. The study was powered to detect a 60% reduction in treatment failure rate from 30% in the physician assessment-based adjustment group (87% power, 2-sided α = 0.025 for each of 2 main comparisons: biomarker or symptom group vs physician group). PATIENT FOLLOW-UP 85% (intention-to-treat analysis). MAIN RESULTS Biomarker and symptom groups did not differ from the physician group for treatment failure (Table) or asthma exacerbations (biomarker vs physician groups, 0.21 vs 0.23 events per person-y, P = 0.89; symptom vs physician groups, 0.12 vs 0.23 events per person-y, P = 0.11). CONCLUSION In adults with mild to moderate asthma, biomarker- or symptom-based adjustment of inhaled corticosteroid dose did not reduce treatment failure compared with physician assessment-based adjustment.Adjustment of ICS dose based on a biomarker (BBA) or symptoms (SBA) vs physician assessment (PABA) in adults with mild to moderate asthma†OutcomeBBASBAPABAAt 36 wkRRR (97.5% CI)NNT (CI)Treatment failure18%-21%13% (-57 to 52)Not significant-14%21%33% (-28 to 65)Not significant†ICS = inhaled corticosteroid; other abbreviations defined in Glossary. Event rates, RRR, and CI calculated from number of events and randomized patients reported in article.
    No preview · Article · Jan 2013 · Annals of internal medicine
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    ABSTRACT: Purpose: Administrative healthcare databases are used for health services research, comparative effectiveness studies, and measuring quality of care. Adjustment for comorbid illnesses is essential to such studies. Validation of methods to account for comorbid illnesses in administrative data for patients with chronic obstructive pulmonary disease (COPD) has been limited. Our objective was to compare the ability of the Charlson index, the Elixhauser method, and the Johns Hopkins' Aggregated Diagnosis Groups (ADGs) to predict outcomes in patients with COPD. Methods: Retrospective cohorts constructed using population-based administrative data of patients with incident (n = 216,735) and prevalent (n = 638,926) COPD in Ontario, Canada, were divided into derivation and validation datasets. The primary outcome was all-cause death within 1 year. Secondary outcomes included all-cause hospitalization, COPD-specific hospitalization, non-COPD hospitalization, and COPD exacerbations. Results: In both the incident and prevalent COPD cohorts, the three methods had comparable discrimination for predicting mortality (c-statistics in the validation sample of incident patients of 0.819 for the Charlson method versus 0.822 for the Elixhauser method versus 0.830 for the ADG method). All three methods had lower predictive accuracy for predicting nonfatal outcomes. Conclusions: In a disease-specific cohort of COPD patients, all three methods allowed for accurate prediction of mortality, with the Johns Hopkins ADGs having marginally higher discrimination.
    No preview · Article · Oct 2012 · Annals of epidemiology
  • Matthew B Stanbrook
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    ABSTRACT: Wells et al.(1) report in the Journal the association between pulmonary artery enlargement, defined as the diameter of the pulmonary artery on computed tomography (CT) greater than the corresponding diameter of the aorta (PA:A ratio >1), and an increased risk of future exacerbations of chronic obstructive pulmonary disease (COPD). An increased PA:A ratio had a greater association with future COPD exacerbations than any other variable evaluated, including a history of exacerbations. Although these findings are noteworthy, their implications for clinical practice are not yet clear. Many randomized trials showing that existing therapies are effective in reducing exacerbations of COPD have . . .
    No preview · Article · Sep 2012 · New England Journal of Medicine
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    Noni E MacDonald · Daniel Rosenfield · Ken Flegel · Matthew B Stanbrook

    Full-text · Article · Apr 2012 · Canadian Medical Association Journal
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    Donald A Redelmeier · Matthew B Stanbrook

    Preview · Article · Apr 2012 · Canadian Medical Association Journal

Publication Stats

871 Citations
1,032.40 Total Impact Points


  • 2000-2015
    • University of Toronto
      • • Division of Respirology
      • • Department of Physical Therapy
      • • Institute of Health Policy, Management and Evaluation
      • • Department of Medicine
      Toronto, Ontario, Canada
  • 2010-2014
    • University Health Network
      • Department of Medicine
      Toronto, Ontario, Canada
    • The University of Calgary
      Calgary, Alberta, Canada
  • 2009-2011
    • Toronto Western Hospital
      Toronto, Ontario, Canada
  • 2007-2011
    • University of Ottawa
      • • Department of Medicine
      • • Department of Pediatrics
      • • Faculty of Law
      Ottawa, Ontario, Canada
  • 2008-2009
    • The University of Western Ontario
      London, Ontario, Canada