Table 7.
Adjusted multilevel regression analysis of health centre and patient level factors on delivery of guideline scheduled Type 2 diabetes services (n = 10,674 clients; 132 health centres)
| Outcome is >76% service delivery | Empty Model A | Model B | Model C | ||||
|---|---|---|---|---|---|---|---|
| Predictors | Fixed effects | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Audit Year | 2005/2006 | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) |
| 2007 | 1.62 | (1.32-1.98)*** | 1.14 | (0.91-1.44) | 1.20 | (0.95-1.51) | |
| 2008 | 1.90 | (1.57-2.32)*** | 1.21 | (0.95-1.54) | 1.30 | (1.02-1.67)* | |
| 2009 | 2.41 | (1.99-2.93)*** | 1.35 | (1.03-1.77)* | 1.40 | (1.07-1.83)* | |
| 2010 | 2.23 | (1.80-2.76)*** | 1.16 | (0.86-1.57) | 1.17 | (0.86-1.59) | |
| 2011 | 2.40 | (1.97-2.93)*** | 1.25 | (0.92-1.71) | 1.24 | (0.91-1.69) | |
| 2012 | 2.89 | (2.37-3.53)*** | 1.18 | (0.82-1.68) | 1.17 | (0.82-1.67) | |
| Health Centre Characteristics | |||||||
| Location X duration of CQI participation | |||||||
| Non-remote: | Baseline | 1.00 | (reference) | 1.00 | (reference) | ||
| 1-2 cycles | 1.53 | (1.10-2.11)* | 1.47 | (1.06-2.04)* | |||
| ≥3 cycles | 1.62 | (1.02-2.55)* | 1.55 | (0.98-2.45) | |||
| Remote: | Baseline | 1.00 | (reference) | 1.00 | (reference) | ||
| 1-2 cycles | 2.92 | (1.36-6.24)** | 2.91 | (1.36-6.22)** | |||
| ≥3 cycles | 3.14 | (1.37-7.18)** | 3.29 | (1.44-7.54)** | |||
| Very Remote: | Baseline | 1.00 | (reference) | 1.00 | (reference) | ||
| 1-2 cycles | 4.03 | (2.27-7.16)*** | 4.31 | (2.43-7.67)*** | |||
| ≥3 cycles | 4.72 | (2.47-9.02)*** | 5.05 | (2.63-9.67)*** | |||
| Patient attendance in last 6 months | Lower attendance | 1.00 | (reference) | 1.00 | (reference) | ||
| Higher attendance | 1.40 | (1.22-1.60)*** | 1.40 | (1.22-1.61)*** | |||
| Patient Characteristics (Age X disease status) | |||||||
| ≥15- < 25 years: Comorbidity | One condition | 1.00 | (reference) | ||||
| 2 or more conditions | 1.83 | (0.85-3.94) | |||||
| ≥15- < 25 years: Complications | None | 1.00 | (reference) | ||||
| 1-2 complications | 0.87 | (0.13-5.68) | |||||
| >2 complications | 5.82 | (0.45-74.5) | |||||
| ≥25- < 40 years: Comorbidity | One condition | 1.00 | (reference) | ||||
| 2 or more conditions | 1.38 | (1.10-1.73)** | |||||
| ≥25- < 40 years: Complications | None | 1.00 | (reference) | ||||
| 1-2 complications | 2.40 | (1.53-3.77)*** | |||||
| >2 complications | 1.73 | (0.72-4.13) | |||||
| ≥40- < 55 years: Comorbidity | One condition | 1.00 | (reference) | ||||
| 2 or more conditions | 1.43 | (1.20-1.69)*** | |||||
| ≥40- < 55 years: Complications | None | 1.00 | (reference) | ||||
| 1-2 complications | 1.32 | (1.05-1.65)* | |||||
| >2 complications | 1.17 | (0.80-1.70) | |||||
| ≥55 years: Comorbidity | One condition | 1.00 | (reference) | ||||
| 2 or more conditions | 1.26 | (1.05-1.52)* | |||||
| ≥55 years: Complications | None | 1.00 | (reference) | ||||
| 1-2 complications | 1.29 | (1.05-1.58)* | |||||
| >2 complications | 1.45 | (1.04-2.01)* | |||||
| Random effects (intercepts) | |||||||
| State (variance (SE)) | 1.41 | (0.99) | 0.72 | (0.53) | 0.69 | (0.51) | |
| MOR STATE | 3.10 | 2.24 | 2.21 | ||||
| PCV (% explained variance) | 49% | 51% | |||||
| Health Centre (variance (SE)) | 1.21 | (0.19) | 0.93 | (0.15) | 0.94 | (0.15) | |
| MOR HC | 2.86 | 2.51 | 2.52 | ||||
| PCV (% explained variance) | 23% | 23% | |||||
| State & Health Centre (variance) | 2.62 | 1.65 | 1.63 | ||||
| MOR STATE-HC | 4.68 | 3.41 | 3.38 | ||||
| PCV (% explained variance) | 37% | 38% | |||||
| Patient (variance (SE)) | 0.13 | (0.072) | 0.07 | (0.03) | 0.02 | (0.012) | |
| PCV (% explained variance) | 44% | 81% | |||||
*p < 0.05; **p < 0.01; ***p < 0.0001.
MOR (Median odds ratio): odds of receiving ‘top quartile service delivery’ if a patient was to change health centre or jurisdiction [17].
PCV (Proportional change in variance): percent variation explained in odds for better health care delivery by introduction of health centre or patient level factors [16].