. 2017 Sep 5;177(9):1326–1333. doi: 10.1001/jamainternmed.2017.2649

Table 3. Patient- and Physician-Level Indicators for a Downstream Cardiac Consultation, Test, or Procedure in 2 352 324 Patients Within 3 Months After an Annual Health Examination Based on a Multilevel Logistic Regression With a Random Intercept for Practice-Level Effects .

Fixed Effects	OR (95% CI)^a
Fixed Effects	Cardiac Consultations (n = 36 085)	TTE (n = 83 463)	Stress Test (n = 42 923)	Nuclear Stress Test (n = 15 651)
Patient characteristics
ECG by AHE after 30 days^b	5.38 (5.24-5.52)^c	7.09 (6.97-7.22)^c	6.48 (6.33-6.64)^c	4.21 (4.04-4.38)^c
Physician ECG ordering quintile
2 vs 1 (lowest)	1.03 (0.99-1.08)	1.18 (1.14-1.23)^c	1.08 (1.03-1.13)^c	1.01 (0.94-1.09)^c
3 vs 1 (lowest)	1.00 (0.95-1.04)	1.28 (1.23-1.33)^c	1.21 (1.15-1.26)^c	1.03 (0.95-1.11)
4 vs 1 (lowest)	0.73 (0.70-0.77)^c	1.09 (1.05-1.13)^c	0.91 (0.87-0.96)^c	0.91 (0.85-0.99)^c
5 vs 1 (lowest)	0.37 (0.35-0.39)^c	0.60 (0.58-0.63)^c	0.53 (0.50-0.55)^c	0.61 (0.57-0.66)^c
Age group, y
45-64 vs 18-44	1.62 (1.58-1.67)^c	1.27 (1.25-1.29)^c	1.81 (1.77-1.85)^c	3.47 (3.33-3.63)^c
≥65 vs 18-44	2.77 (2.68-2.87)^c	1.97 (1.92-2.02)^c	1.74 (1.68-1.81)^c	6.25 (5.92-6.59)^c
Male vs female	1.75 (1.71-1.79)^c	1.23 (1.21-1.25)^c	1.79 (1.75-1.83)^c	1.32 (1.28-1.37)^c
Neighborhood income quintile
2 vs 1 (Lowest)	1.02 (0.98-1.05)	0.91 (0.89-0.93)^c	0.95 (0.92-0.98)^c	0.95 (0.90-1.01)
3 vs 1 (Lowest)	1.01 (0.98-1.05)	0.92 (0.90-0.95)^c	0.97 (0.94-1.01)	0.94 (0.89-0.99)^c
4 vs 1 (Lowest)	1.03 (0.99-1.07)	0.89 (0.87-0.91)^c	0.97 (0.94-1.01)	0.95 (0.90-1.00)
5 vs 1 (Lowest)	1.04 (1.00-1.07)	0.89 (0.87-0.92)^c	0.96 (0.93-0.99)^c	0.93 (0.88-0.98)^c
Hospital admission last 3 y	1.48 (1.42-1.54)^c	0.94 (0.91-0.97)^c	0.85 (0.81-0.90)^c	1.02 (0.95-1.10)
Cancer	1.75 (1.70-1.80)^c	1.09 (1.07-1.12)^c	1.02 (0.99-1.05)	1.77 (1.70-1.84)^c
COPD	1.16 (1.11-1.21)^c	1.04 (1.00-1.07)	1.03 (0.98-1.08)	1.25 (1.17-1.33)^c
Asthma	1.06 (1.02-1.09)^c	0.99 (0.97-1.01)	0.94 (0.91-0.97)^c	1.00 (0.95-1.06)
Mental health	1.23 (1.20-1.27)^c	0.99 (0.97-1.01)	1.00 (0.97-1.03)	1.09 (1.04-1.14)^c
Dementia	1.48 (1.31-1.68)^c	0.98 (0.88-1.11)	0.89 (0.75-1.06)	1.00 (0.82-1.23)
Rheumatologic disease	1.44 (1.39-1.51)^c	1.03 (1.00-1.06)	0.97 (0.93-1.02)	1.21 (1.14-1.28)^c
Rural	1.02 (0.97-1.07)	0.98 (0.88-1.10)	1.00 (0.96-1.05)	0.87 (0.8-0.94)^c
Physician characteristics
Sex
Male	0.96 (0.94-0.99)^c	1.00 (0.98-1.01)	0.96 (0.93-0.98)^c	1.09 (1.05-1.13)^c
Female	1 [Reference]	1 [Reference]	1 [Reference]	1 [Reference]
IMG	1.14 (1.11-1.17)^c	1.14 (1.12-1.16)^c	1.11 (1.08-1.14)^c	1.19 (1.15-1.24)^c
Years since graduation (mean), y
21-30 vs 0-20	0.93 (0.90-0.95)^c	0.95 (0.93-0.96)^c	0.87 (0.85-0.90)^c	0.88 (0.85-0.92)^c
>30 vs 0-20	0.89 (0.87-0.92)^c	0.88 (0.87-0.90)^c	0.77 (0.75-0.80)^c	0.86 (0.82-0.90)^c
Organizational structure
Family health group vs FFS	0.87 (0.83-0.90)^c	0.85 (0.83-0.87)^c	0.82 (0.79-0.85)^c	0.87 (0.82-0.93)^c
Family health network vs FFS	1.01 (0.74-1.37)	1.15 (0.89-1.50)	0.59 (0.41-0.85)^c	0.79 (0.49-1.27)
Family health organization vs FFS	0.88 (0.83-0.92)^c	0.83 (0.79-0.86)^c	0.89 (0.84-0.94)^c	0.79 (0.73-0.86)^c
Family health team vs FFS	0.98 (0.93-1.04)	0.92 (0.88-0.96)^c	0.98 (0.92-1.05)	0.82 (0.76-0.90)^c
Other vs FFS	0.87 (0.78-0.97)^c	0.55 (0.52-0.59)^c	0.87 (0.78-0.97)^c	0.83 (0.70-0.97)^c
Random effects
Practice^d	1.47 (1.45-1.49)^c	1.60 (1.57-1.63)^c	1.71 (1.68-1.75)^c	1.56 (1.53-1.60)^c

Abbreviations: AHE, annual health examination; COPD, chronic obstructive pulmonary disease; ECG, electrocardiograms; OR, odds ratio; TTE, transthoracic echocardiogram.

^{^a}

All odds ratios presented are adjusted for all other factors in the table. All reported values based on SAS (version 9.4) PROC GLIMMIX output; model estimation method = RSPL; denominator degrees of freedom estimation method = between and within; covariance structure = standard variance.

^{^b}

Indicates patient had an ECG within 30 days after AHE.

^{^c}

P < .05.

^{^d}

Median odds ratio reported with 95% CI in parentheses.