Table 2.
Association of Social Complexity Factors With Indicators of the Quality of Primary Care
| Quality Indicator | Likelihood of Receipt, Odds Ratio (99% CI)a | P Valueb | ||||
|---|---|---|---|---|---|---|
|
| ||||||
| 1 Factor | 2 Factors | 3 Factors | 4 Factors | ≥5 Factors | ||
| Prevention and screening | ||||||
| Breast cancer screening (women 50–74 y) | 0.77 (0.73–0.81) | 0.54 (0.50–0.58) | 0.38 (0.34–0.42) | 0.28 (0.24–0.33) | 0.22 (0.18–0.27) | <.001 |
| Cervical cancer screening (women 21–69 y) | 1.04 (1.00–1.08) | 0.96 (0.92–1.01) | 0.87 (0.81–0.92) | 0.94 (0.87–1.02) | 1.01 (0.93–1.09) | .003 |
| Colorectal cancer screening (adults 50–74 y) | 0.83 (0.80–0.86) | 0.66 (0.63–0.70) | 0.51 (0.47–0.56) | 0.40 (0.35–0.46) | 0.36 (0.30–0.44) | .001 |
| Completed vaccinations at 2 y | 0.70 (0.61–0.81) | 0.55 (0.46–0.66) | 0.41 (0.33–0.50) | 0.33 (0.26–0.43) | 0.26 (0.19–0.36) | <.001 |
| Annual influenza vaccination (adults ≥65 y) | 0.88 (0.83–0.93) | 0.74 (0.68–0.82) | 0.69 (0.59–0.81) | 0.68 (0.52–0.89) | 1.17 (0.76–1.79) | <.001 |
| Annual influenza vaccination (total respiratory morbidity) | 0.84 (0.80–0.87) | 0.75 (0.70–0.79) | 0.74 (0.69–0.80) | 0.67 (0.61–0.74) | 0.64 (0.58–0.71) | .02 |
| Pneumococcal vaccination (adults ≥65 y) | 0.95 (0.90–1.01) | 0.88 (0.80–0.97) | 0.90 (0.76–1.07) | 0.90 (0.69–1.18) | 0.90 (0.59–1.39) | .001 |
| Chronic disease management | ||||||
| Diabetes management: eye examination | 0.86 (0.79–0.92) | 0.78 (0.70–0.87) | 0.70 (0.61–0.82) | 0.69 (0.58–0.84) | 0.52 (0.42–0.64) | <.001 |
| CHF management: initiation of ACE inhibitor | 0.90 (0.73–1.11) | 0.72 (0.53–0.99) | 0.80 (0.50–1.29) | 0.59 (0.32–1.09) | 0.41 (0.19–0.88) | <.001 |
| CHF management: persistence of ACE inhibitor | 0.85 (0.69–1.05) | 0.77 (0.56–1.05) | 0.63 (0.39–1.01) | 0.74 (0.40–1.36) | 0.27 (0.11–0.63) | .045 |
| Post-MI management: initiation of β-blocker | 1.16 (0.76–1.77) | 0.80 (0.45–1.43) | 0.96 (0.39–2.37) | 0.30 (0.12–0.76) | 0.48 (0.14–1.67) | .04 |
| Post-MI management: persistence of β-blocker | 0.97 (0.72–1.31) | 0.77 (0.50–1.19) | 0.75 (0.40–1.39) | 0.66 (0.29–1.52) | 0.94 (0.34–2.66) | .65 |
| Post-MI management: initiation of statin | 0.87 (0.64–1.17) | 0.81 (0.52–1.25) | 0.63 (0.34–1.19) | 0.43 (0.19–0.98) | 0.91 (0.31–2.69) | .02 |
| Post-MI management: persistence of statin | 0.75 (0.56–1.01) | 0.76 (0.49–1.16) | 0.49 (0.26–0.92) | 0.46 (0.20–1.05) | 0.82 (0.30–2.24) | .004 |
| Asthma management: medication use | 0.90 (0.82–0.99) | 0.90 (0.80–1.01) | 0.81 (0.71–0.94) | 0.81 (0.69–0.96) | 0.88 (0.75–1.04) | .001 |
| Medications | ||||||
| Benzodiazepine prescription (community-dwelling adults ≥75 y) | 1.63 (1.48–1.80) | 2.16 (1.82–2.56) | 3.15 (2.25–4.40) | 3.03 (1.36–6.71) | 3.08 (0.68–14.00) | <.001 |
| Beers List drug prescription (community-dwelling adults ≥65 y) | 1.39 (1.31–1.47) | 1.92 (1.74–2.12) | 2.37 (2.01–2.79) | 3.50 (2.67–4.60) | 4.05 (2.61–6.28) | <.001 |
| Depression care: prescription follow-up | 1.07 (0.90–1.28) | 1.09 (0.88–1.35) | 1.09 (0.83–1.42) | 1.21 (0.89–1.64) | 1.46 (1.08–1.99) | .004 |
| Health services use | ||||||
| Hospitalizations for ACSC (adults ≥74 y) | 1.43 (1.11–1.84) | 2.40 (1.77–3.24) | 3.58 (2.52–5.08) | 4.80 (3.24–7.11) | 5.64 (3.70–8.60) | <.001 |
| Radiograph for low back pain (adults ≥20 y) | 0.92 (0.73–1.15) | 1.02 (0.76–1.37) | 0.80 (0.54–1.18) | 0.83 (0.50–1.37) | 1.10 (0.68–1.80) | .34 |
| Hospital episodes with readmission within 30 d | 1.23 (1.11–1.36) | 1.41 (1.25–1.60) | 1.86 (1.62–2.15) | 1.91 (1.63–2.24) | 2.21 (1.89–2.58) | <.001 |
| ED visits for low-acuity (CTAS 4 and 5c) patients | 1.21 (1.17–1.24) | 1.54 (1.50–1.60) | 2.02 (1.95–2.10) | 2.61 (2.51–2.72) | 3.38 (3.24–3.51) | <.001 |
| Ambulatory visits to primary care | 1.09 (1.08–1.09) | 1.19 (1.19–1.20) | 1.29 (1.28–1.29) | 1.41 (1.40–1.42) | 1.62 (1.61–1.62) | .001 |
| Ambulatory visits for patients with RUB of 3, 4, or 5 | 1.11 (1.09–1.13) | 1.26 (1.23–1.29) | 1.44 (1.36–1.51) | 1.70 (1.55–1.86) | 2.12 (1.88–2.39) | <.001 |
| Ambulatory visits with a call to health telephone service within 2 d of visit | 1.02 (0.97–1.06) | 1.14 (1.08–1.20) | 1.33 (1.25–1.42) | 1.53 (1.43–1.64) | 1.75 (1.63–1.87) | <.001 |
ACE = angiotensin-converting enzyme; ACSC = ambulatory care–sensitive conditions; CHF = congestive heart failure; CTAS = Canadian Triage Acuity Scale; ED = emergency department; MI = myocardial infarction; RUB = resource utilization band.
Note: Adjusted for sex, age, income quintile, and morbidity level (RUB).
a
Compared with patients having no social complexity factors.
b
For trend across factor categories.
c
On a scale of 1 to 5, with 5 being lowest acuity.