Table 4. Adjusted associations of organizational determinants with readmissions for heart failure, expressed in terms of incidence rate ratios (IRRs) derived from multilevel Poisson regression models.
| Variables | Short-term | Medium-term | Mid-long-term | Long-term | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IRR a | 95% CI | P value | IRR b | 95% CI | P value | IRR c | 95% CI | P value | IRR d | 95% CI | P value | |
| Patient characteristics | ||||||||||||
| Discharge from a cardiology department | ||||||||||||
| No | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| Yes | 0.51 | 0.22–1.17 | 0.114 | 0.91 | 0.58–1.44 | 0.687 | 1.15 | 0.67–1.97 | 0.623 | 0.95 | 0.60–1.48 | 0.811 |
| GP characteristics | ||||||||||||
| Organizational arrangement | ||||||||||||
| None/Simple association | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| Network | 1.09 | 0.63–1.91 | 0.751 | 1.22 | 0.82–1.80 | 0.324 | 1.10 | 0.76–1.59 | 0.599 | 1.10 | 0.82–1.47 | 0.539 |
| Group practice | 1.28 | 0.68–2.40 | 0.449 | 1.31 | 0.85–2.04 | 0.223 | 1.26 | 0.82–1.92 | 0.295 | 1.16 | 0.80–1.69 | 0.438 |
| Number of patients in the roster | ||||||||||||
| <1000 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| 1000–1499 | 0.94 | 0.47–1.85 | 0.849 | 1.06 | 0.65–1.74 | 0.804 | 1.06 | 0.72–1.56 | 0.768 | 1.24 | 0.87–1.78 | 0.236 |
| ≥1500 | 0.90 | 0.45–1.79 | 0.757 | 1.09 | 0.66–1.78 | 0.738 | 0.85 | 0.54–1.36 | 0.501 | 0.99 | 0.67–1.47 | 0.952 |
| PCU characteristics | ||||||||||||
| Number of GPs | ||||||||||||
| ≤15 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| >15 | 1.19 | 0.69–2.07 | 0.535 | 1.11 | 0.78–1.59 | 0.564 | 1.01 | 0.76–1.36 | 0.932 | 0.97 | 0.73–1.28 | 0.822 |
| Number of nurses’ weekly working hours | ||||||||||||
| ≤350 | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| >350 | 0.97 | 0.55–1.72 | 0.915 | 0.88 | 0.61–1.28 | 0.508 | 0.80 | 0.61–1.07 | 0.128 | 0.90 | 0.70–1.17 | 0.431 |
| Diagnostic/therapeutic pathway for heart failure | ||||||||||||
| No | 1.00 | 1.00 | 1.00 | 1.00 | ||||||||
| Yes | 0.57 | 0.35–0.92 | 0.020 | 0.70 | 0.51–0.96 | 0.026 | 0.79 | 0.64–0.98 | 0.029 | 0.82 | 0.67–0.99 | 0.043 |
| Pseudo R 2 e | 5.5% | 4.8% | 7.2% | 9.3% | ||||||||
aAdjusted for significant covariates, including: other forms of ischemic heart disease, chronic nephropathies, and previous use of drugs for cardiac therapy.
bAdjusted for significant covariates, including: patients’ age, diabetes, cardiomyopathies, chronic nephropathies, and previous use of drugs for cardiac therapy.
cAdjusted for significant covariates, including: patients’ age, diabetes, COPD, chronic nephropathies, and previous use of drugs for cardiac therapy.
dAdjusted for significant covariates, including: patients’ age, diabetes, other cardiac diseases, COPD, chronic nephropathies, and previous use of antihypertensive drugs.
ePseudo R 2 indicates how much of the variation of the phenomenon was explained by the covariates included in the model.
Abbreviations: IRR, incidence rate ratio; 95% CI, 95% confidence interval.