Table 3.
Fixed and random effects from three-level random intercept logistic regression models for diabetes screening (N = 56,818)
| Hierarchical nested three-level models | Cross-classified model | ||||
|---|---|---|---|---|---|
| Model 1 | Model 2 | Model 3 | Model 4 | ||
| Unconditional model | With patient-level factors only | With patient- and clinic-level factors | With patient-, clinic-, and provider-level factors | With patient-, clinic-, and provider-level factors | |
| Random effects | |||||
| Variance (SE) | |||||
| Clinic | 0.311 (0.15) | 0.276 (0.14) | 0.284 (0.15) | 0.233 (0.13) | 0.234 (0.13) |
| Provider in clinic | 0.420 (0.04) | 0.299 (0.06) | 0.303 (0.06) | 0.274 (0.06) | 0.281 (0.06) |
| Intraclass correlation | 0.185 | 0.149 | 0.151 | 0.134 | 0.135 |
| MOR | 2.261 | 2.061 | 2.08 | 1.97 | 1.98 |
| AIC, BIC | 61,919, 61,921 | 7,301, 7,312 | 7,303, 7,314 | 7,298, 7,310 | 7,301, 7,253 |
| Fixed effects | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | AOR (95% CI) | |
| Patient-level factors | |||||
| Age | — | 1.01 (1.01, 1.02) | 1.01 (1.01, 1.02) | 1.01 (1.01, 1.02) | 1.01 (1.01, 1.02) |
| BMI | — | 1.03 (1.02, 1.04) | 1.03 (1.02, 1.04) | 1.03 (1.02, 1.04) | 1.03 (1.02, 1.04) |
| Sex | |||||
| Male | — | Reference | Reference | Reference | Reference |
| Female | — | 1.26 (1.11, 1.42) | 1.26 (1.11, 1.42) | 1.26 (1.11, 1.42) | 1.25 (1.11, 1.41) |
| Race/ethnicity | |||||
| White | — | Reference | Reference | Reference | Reference |
| Black | — | 1.01 (0.86, 1.18) | 1.02 (0.87, 1.19) | 1.02 (0.87, 1.20) | 1.02 (0.87, 1.20) |
| Hispanic | — | 1.03 (0.87, 1.23) | 1.04 (0.88, 1.24) | 1.05 (0.88, 1.24) | 1.04 (0.88, 1.24) |
| Other | — | 1.06 (0.76, 1.48) | 1.09 (0.78, 1.53) | 1.10 (0.79, 1.54) | 1.10 (0.79, 1.54) |
| Prediabetes | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.55 (1.14, 2.12) | 1.53 (1.12, 2.09) | 1.53 (1.12, 2.09) | 1.52 (1.12, 2.07) |
| Family history of diabetes | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.12 (0.97, 1.30) | 1.12 (0.97, 1.30) | 1.12 (0.97, 1.30) | 1.13 (0.98, 1.30) |
| Hyperlipidemia | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.71 (1.49, 1.96) | 1.71 (1.49, 1.96) | 1.70 (1.48, 1.95) | 1.70 (1.48, 1.95) |
| Hypertension | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.23 (1.07, 1.40) | 1.23 (1.07, 1.40) | 1.22 (1.07, 1.39) | 1.22 (1.07, 1.39) |
| Gestational diabetes | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 0.96 (0.27, 3.43) | 1.01 (0.28, 3.61) | 1.06 (0.29, 3.85) | 1.09 (0.30, 3.95) |
| Infant >9 lbs | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.91 (0.78, 4.68) | 1.98 (0.80, 4.89) | 1.92 (0.78, 4.73) | 1.92 (0.78, 4.72) |
| Cardiovascular disease | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 1.05 (0.84, 1.31) | 1.05 (0.84, 1.32) | 1.05 (0.84, 1.31) | 1.05 (0.84, 1.32) |
| Employment status | |||||
| Employed | — | Reference | Reference | Reference | Reference |
| Not employed | — | 0.92 (0.80, 1.05) | 0.92 (0.80, 1.05) | 0.92 (0.80, 1.05) | 0.92 (0.80, 1.06) |
| Marital status | |||||
| Married | — | Reference | Reference | Reference | Reference |
| Not married | — | 0.80 (0.70, 0.92) | 0.81 (0.70, 0.92) | 0.81 (0.70, 0.92) | 0.81 (0.70, 0.93) |
| Insurance | |||||
| Uninsured | — | Reference | Reference | Reference | Reference |
| Insured* | — | 0.79 (0.69, 0.91) | 0.79 (0.69, 0.91) | 0.80 (0.69, 0.91) | 0.79 (0.69, 0.91) |
| Self-pay | — | 0.73 (0.53, 1.01) | 0.75 (0.54, 1.04) | 0.74 (0.54, 1.03) | 0.74 (0.54, 1.03) |
| Ever smoked | |||||
| No | — | Reference | Reference | Reference | Reference |
| Yes | — | 0.80 (0.70, 0.91) | 0.80 (0.71, 0.91) | 0.80 (0.71, 0.91) | 0.80 (0.71, 0.91) |
| Clinic-level factor | |||||
| Clinic type | |||||
| Teaching | — | Reference | Reference | Reference | Reference |
| Nonteaching | — | — | 1.01 (0.71, 1.45) | 1.07 (0.74, 1.55) | 1.06 (0.74, 1.54) |
| Provider-level factor | |||||
| Provider type | |||||
| Attending/physician | — | Reference | Reference | Reference | Reference |
| NP/PA/MW | — | — | — | 0.64 (0.46, 0.89) | 0.66 (0.47, 0.93) |
| Physician in training‡ | — | — | — | 1.23 (0.76, 1.99) | 1.32 (0.81, 2.14) |
Boldface type indicates statistical significance. AIC, Akaike information criterion; AOR, adjusted odds ratio; BIC, Bayesian information criterion; MW, midwife; NP, nurse pratitioner, PA, physician assistant.
*
Insured includes commercial and Medicaid.
‡
Physician in training includes residents and fellows.