Table 3.
Rapidity and modality of imaging for Medicare patients with acute low back pain and the individual and practice characteristics of their primary care physiciansa
| Characteristics | N (%) Total = 35,039 |
Adjusted Odds Ratiob (95% CI) |
Adjusted Odds Ratiob (95% CI) |
|---|---|---|---|
| Characteristics of Patients | |||
| Age | |||
| 65-74 | 19,856 (56.7) | 1.00 | 1.00 |
| 75-84 | 12,345 (35.2) | 1.10 (1.02-1.18)a | 1.07 (1.01-1.14)a |
| >84 | 2,838 (8.1) | 1.02 (0.89-1.17) | 0.96 (0.85-1.09) |
| Male | 24,281 (69.3) | 1.00 | 1.00 |
| Female | 10,758 (30.7) | 1.04 (0.96-1.13) | 1.04 (0.96-1.13) |
| Race | |||
| White | 30,746 (87.8) | 1.00 | 1.00 |
| Black | 2,626 (7.5) | 0.84 (0.75-0.95)b | 0.88 (0.78-0.99)a |
| Other | 1,667 (4.8) | 0.70 (0.53-0.93)a | 0.72 (0.52-0.94)b |
| Not Medicaid eligible | 30,664 (87.5) | 1.00 | 1.00 |
| Medicaid eligible | 4,375 (12.5) | 0.80 (0.67-0.94)b | 0.79 (0.66-0.94)b |
| Klabunde score (mean) | 35,039 (100) | 1.09 (1.02-1.17)b | 1.09 (1.02-1.16)a |
| Charlson index | |||
| No comorbidities | 31,684 (90.4) | 1.00 | 1.00 |
| 1 comorbidity | 1,711 (4.9) | 1.16 (0.97-1.38) | 1.21 (1.03-1.42)a |
| ≥2 comorbidities | 1,644 (4.7) | 0.90 (0.73-1.11) | 0.92 (0.73-1.15) |
| Median household income in patient’s zip code |
|||
| Above county median | 17,693 (50.5) | 1.00 | 1.00 |
| Below county median | 16,599 (47.5) | 1.00 (0.92-1.10) | 0.93 (0.86-0.99)a |
|
|
|||
|
Characteristics of the PCP and his or
her practice |
|||
| Specialty | |||
| General internal medicine | 16,835 (48.0) | 1.00 | 1.00 |
| Family/general practice | 18,204 (52.0) | 0.92 (0.86-0.99)a | 0.93 (0.86-1.00)a |
| Years in practice | |||
| 0-10 | 9,452 (27.0) | 1.00 | 1.00 |
| 11-20 | 12,574 (35.9) | 0.99 (0.92-1.08) | 0.99 (0.92-1.07) |
| >20 | 13,013 (37.1) | 0.99 (0.90-1.09) | 1.00 (0.90-1.10) |
| Board certified | 30,640 (87.5) | 1.00 | 1.00 |
| Not board certified | 4,320 (12.3) | 0.99 (0.86-1.14) | 0.97 (0.84-1.12) |
| Medical school outside U.S./Canada | 5,958 (17.0) | 1.00 | 1.00 |
| U.S./Canadian medical school | 29,071 (83.0) | 1.03 (0.93-1.14) | 1.05 (0.96-1.15) |
| Practice type | |||
| Solo/2-person | 15,452 (44.1) | 1.00 | 1.00 |
| Small group, 3-10 | 7,104 (20.3) | 1.11 (0.97-1.26) | 1.07 (0.94-1.22) |
| Medium group, 11-50 | 2,877 (8.2) | 1.50 (1.28-1.77)c | 1.37 (1.19-1.58)c |
| Large group, >50 | 1,366 (3.9) | 1.24 (1.01-1.53)a | 1.21 (1.02-1.44)a |
| Medical school | 822 (2.4) | 0.93 (0.72-1.20) | 0.91 (0.72-1.16) |
| Hospital practice/Other | 6,889 (19.7) | 1.02 (0.89-1.17) | 1.02 (0.90-1.15) |
| Group/staff HMO | 529 (1.5) | 0.97 (0.73-1.29) | 1.01 (0.76-1.36) |
| Practice revenue derived from Medicaid | |||
| 0-5% | 17,824 (50.9) | 1.00 | 1.00 |
| 6-15% | 10,908 (31.1) | 0.92 (0.84-1.00)a | 0.92 (0.85-1.00)a |
| >15% | 6,307 (18.0) | 0.84 (0.76-0.93)c | 0.85 (0.77-0.94)c |
| Practice revenue derived from capitation | |||
| None | 16,659 (47.5) | 1.00 | 1.00 |
| 1-10% | 7,489 (21.4) | 1.00 (0.83-1.07) | 0.99 (0.93-1.06) |
| 11-25% | 4,330 (12.4) | 1.08 (0.95-1.23) | 1.07 (0.95-1.21) |
| >25% | 6,561 (18.7) | 0.93 (0.83-1.03) | 0.89 (0.81-0.98)a |
| Practice ownership | |||
| Full owner | 14,830 (42.3) | 1.00 | 1.00 |
| Part-owner | 9,298 (26.5) | 0.88 (0.90-0.97)b | 0.89 (0.90-0.98)a |
| Employed | 10,911 (31.1) | 0.80 (0.70-0.93)b | 0.82 (0.71-0.95)b |
| Financial incentives | |||
| None of three types of incentives | 2,828 (8.1) | 1.00 | 1.00 |
| Only clinical quality incentives | 63 (0.2) | 0.73 (0.43-1.25) | 0.62 (0.39-1.01) |
| Only patient satisfaction incentives | 122 (0.4) | 3.41 (2.70-4.30)c | 2.63 (2.12-3.26)c |
| Only productivity incentives | 13,240 (37.8) | 0.97 (0.87-1.09) | 0.97 (0.87-1.09) |
| Clinical quality and patient satisfaction, but not productivity incentives |
144 (0.4) | 0.70 (0.52-0.95)a | 0.75 (0.54-1.04) |
| Clinical quality and productivity, but not patient satisfaction incentives |
1,005 (2.9) | 1.01 (0.87-1.17) | 1.01 (0.87-1.16) |
| Productivity and patient satisfaction incentives, but not clinical quality incentives |
2,128 (6.1) | 0.99 (0.85-1.15) | 0.97 (0.83-1.14) |
| All three types of incentives | 3,200 (9.1) | 0.86 (0.73-1.02) | 0.89 (0.76-1.03) |
| Not asked questions on specific incentives |
11,902 (34.0) | 1.07 (0.90-1.28) | 1.05 (0.88-1.26) |
Unweighted counts, weighted percentages, and odds ratios are based on analysis of fee-for-service Medicare claims from 2000-2002 and 2004-2006 for 35,039 fee-for-service Medicare beneficiaries treated by one of 4,567 Community Tracking Study primary care physicians.
CI denotes confidence interval. Adjusted for beneficiary age, sex, Medicaid eligibility, race, and Klabunde and Charlson comorbidity scores; median household income in the beneficiary’s zip code and percentage of adults 25 years or older with at least 12 years of education; the CTS PCP’s specialty, number of years in practice, board certification status, site of medical school, practice ownership status, and exposure to financial incentives based on performance on quality, profiling, patient satisfaction, or productivity; type and size of the CTS PCP’s practice, as well as the percentage of its revenues derived from Medicare, Medicaid, and capitation; urban vs. rural location; radiologist supply per 1,000 capita in the CTS PCP’s county; the round of the survey (2000-2001 or 2004-2005), and the sampling cluster for the CTS survey (site dummy).