Table 5.
Unadjusted and adjusted multilevel logistic regression analysis of health centre and client level factors on composite indicator of recommended STI testing and counselling services (n = 137 health centres; 15,212 patient records)
| Outcome is 100% service delivery | Unadjusted | Model A | Model B | Model C | |||||
|---|---|---|---|---|---|---|---|---|---|
| Predictors | Fixed effects | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Audit Year | 2007 | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) | ||
| 2008 | 0.65 | (0.46-0.91) | 0.79 | (0.55-1.12) | 0.82 | (0.57-1.19) | |||
| 2009 | 0.65 | (0.47-0.92) | 0.73 | (0.51-1.04) | 0.74 | (0.51-1.06) | |||
| 2010 | 0.44 | (0.31-0.63)b | 0.50 | (0.34-0.73)b | 0.49 | (0.33-0.73)b | |||
| 2011 | 0.34 | (0.24-0.47)b | 0.43 | (0.30-0.63)b | 0.43 | (0.29-0.63)b | |||
| 2012 | 0.51 | (0.36-0.72)b | 0.56 | (0.38-0.83)a | 0.57 | (0.38-0.85) | |||
| 2013 | 0.61 | (0.43-0.86) | 0.71 | (0.48-1.05) | 0.71 | (0.48-1.06) | |||
| 2014 | 0.57 | (0.40-0.82)a | 0.66 | (0.43-1.00) | 0.62 | (0.40-0.94) | |||
| Health Centre Characteristics | |||||||||
| Location | Urban | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) | ||
| Regional | 0.25 | (0.12-0.56)a | 0.41 | (0.19-0.86) | 0.38 | (0.18-0.80) | |||
| Remote | 1.71 | (0.88-3.34) | 2.09 | (1.12-3.90) | 1.98 | (1.05-3.74) | |||
| Governance | Community-controlled | 1.00 | (reference) | ||||||
| Government operated | 0.78 | (0.49-1.23) | |||||||
| Service population | ≥1000 | 1.00 | (reference) | ||||||
| >500- < 1000 | 1.30 | (0.78-2.17) | |||||||
| ≤500 | 1.31 | (0.88-1.96) | |||||||
| Length of accreditationa | Never accredited | 1.00 | (reference) | ||||||
| Accredited for some of the time | 1.45 | (0.94-2.24) | |||||||
| Accredited for all of the time | 0.73 | (0.49-1.06) | |||||||
| Duration of participation in ABCD CQI project | Baseline | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) | ||
| 1-2 cycles | 1.49 | (1.35-1.64)b | 1.30 | (1.12-1.50)b | 1.34 | (1.16-1.55)b | |||
| ≥3 cycles | 1.11 | (0.98-1.24) | 0.97 | (0.78-1.20) | 1.01 | (0.81-1.26) | |||
| Provided adult health checkb | No | 1.00 | (reference) | 1.00 | (reference) | 1.00 | (reference) | ||
| Yes | 3.17 | (2.88-3.50)b | 3.25 | (2.94-3.59)b | 3.40 | (3.07-3.77)b | |||
| Patient Characteristics | |||||||||
| Sex | Male | 1.00 | (reference) | 1.00 | (reference) | ||||
| Female | 1.41 | (1.30-1.52)b | 1.45 | (1.33-1.57)b | |||||
| Age (years) | 15-19 | 1.82 | (1.48-2.22)b | 2.10 | (1.67-2.63)b | ||||
| 20-24 | 3.21 | (2.63-3.92)b | 3.84 | (3.07-4.80)b | |||||
| 25-29 | 2.82 | (2.30-3.47)b | 3.01 | (2.39-3.79)b | |||||
| 30-24 | 2.15 | (1.74-2.65)b | 2.35 | (1.85-2.97)b | |||||
| 35-39 | 1.72 | (1.38-2.13)b | 1.77 | (1.39-2.26)b | |||||
| 40-44 | 1.35 | (1.08-1.67) | 1.36 | (1.07-1.73) | |||||
| 45-49 | 1.17 | (0.93-1.47) | 1.27 | (0.99-1.63) | |||||
| 50-54 | 1.00 | (reference) | 1.00 | (reference) | |||||
| Aboriginal Status | Non-Aboriginal | 1.00 | (reference) | 1.00 | (reference) | ||||
| Aboriginal | 2.10 | (1.70-2.61)b | 1.46 | (1.15-1.84)a | |||||
| Not recorded | 1.55 | (1.13-2.12) | 1.09 | (0.77-1.55) | |||||
| Random effects (intercepts) | |||||||||
| State (variance (SE)) | 1.05 | (0.71) | 0.54 | (0.39) | 0.55 | (0.395) | |||
| MORSTATE | 2.66 | 2.02 | 2.03 | ||||||
| PCV (% explained variance) | 48% | 47% | |||||||
| Health Centre (variance (SE)) | 0.84 | (0.14) | 0.54 | (0.09) | 0.55 | (0.095) | |||
| MORHC | 2.39 | 2.01 | 2.03 | ||||||
| PCV (% explained variance) | 36% | 34% | |||||||
| State & Health Centre (variance) | 1.89 | 1.08 | 1.11 | ||||||
| MORSTATE-HC | 3.70 | 2.69 | 2.73 | ||||||
| PCV (% explained variance) | 43% | 41% | |||||||
| Patient (variance (SE)) | 0.28 | (0.14) | 0.12 | (0.055) | 0.03 | (0.015) | |||
| PCV (% explained variance) | 59% | 89% | |||||||
CQI continuous quality improvement, MOR Median Odds Ratio: odds of receiving above median service delivery if client was to change health centre or jurisdiction, OR Odds Ratio, PCV proportional change in variance: per cent variation explained in odds for better healthcare delivery by introduction of health centre or client level factors, SRH Sexual and Reproductive Health
Due to multiple testing, the significance level is set at p < 0.005 (Bonferroni correction); a p < 0.005; b p < 0.0001
a(n = 13,989 with accreditation status recorded); b(n = 13,235 with AHC recorded, introduced to audit tool in 2007)