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Table 2 Multilevel analysis of overall inappropriateness of referral forms: (A) fixed effects; (B) random effects estimates

From: Using text analysis software to identify determinants of inappropriate clinical question reporting and diagnostic procedure referrals in Reggio Emilia, Italy

(A) Risk of overall inappropriateness

Colonoscopy

Gastroscopy

Head CT

Musculoskeletal CT

Head MRI

Musculoskeletal MRI

OR

95%CI

OR

95% CI

OR

95% CI

OR

95% CI

OR

95% CI

OR

95% CI

Year of prescription

 2012

1.00

–

–

1.00

–

–

1.00

–

–

1.00

–

–

1.00

–

–

1.00

–

–

 2013

0.82

0.76

0.87

0.78

0.72

0.83

0.83

0.75

0.91

0.86

0.69

1.07

0.68

0.65

0.71

0.71

0.67

0.75

 2014

0.74

0.69

0.79

0.75

0.70

0.80

0.81

0.74

0.90

0.64

0.52

0.80

0.62

0.59

0.65

0.64

0.61

0.67

 2015

0.59

0.55

0.63

0.66

0.61

0.70

0.74

0.67

0.82

0.58

0.46

0.72

0.53

0.51

0.56

0.50

0.48

0.53

 2016

0.51

0.47

0.55

0.53

0.49

0.57

0.67

0.60

0.74

0.47

0.37

0.60

0.49

0.46

0.51

0.43

0.40

0.46

 2017

0.50

0.47

0.54

0.58

0.54

0.62

0.81

0.73

0.90

0.38

0.30

0.48

0.49

0.46

0.51

0.43

0.41

0.46

Patient’s age

 15–64

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 65–84

0.97

0.92

1.01

0.49

0.47

0.52

1.26

1.18

1.36

1.30

1.10

1.54

1.02

0.98

1.06

1.04

0.98

1.09

  > 84

1.56

1.36

1.79

0.89

0.77

1.02

1.48

1.30

1.69

1.01

0.64

1.61

1.10

0.96

1.27

1.86

1.46

2.38

Patient’s sex

 F

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 M

0.85

0.82

0.88

1.19

1.14

1.23

1.07

1.01

1.13

0.82

0.72

0.94

0.94

0.92

0.97

0.92

0.89

0.96

Fee exemption

 No

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 Yes

1.01

0.96

1.07

0.98

0.92

1.03

1.00

0.92

1.08

0.90

0.74

1.08

1.45

1.39

1.51

1.12

1.06

1.20

Physician’s sex

 F

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 M

1.33

1.14

1.56

1.18

1.02

1.36

1.05

0.92

1.21

1.16

0.92

1.48

1.09

0.93

1.26

1.09

0.92

1.29

Physician’s age

 28–44

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 45–68

1.14

0.85

1.53

1.08

0.82

1.43

1.07

0.82

1.40

2.17

1.30

3.62

0.94

0.73

1.21

0.99

0.72

1.34

GPs’ practice organization

 Primary care medical group

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

1.00

  

 Primary care medical network

1.39

1.16

1.67

1.40

1.20

1.63

1.15

1.00

1.32

1.43

1.11

1.84

1.36

1.14

1.63

1.40

1.15

1.69

(B) Variances of random effects a

Variance

ICC %

Variance

ICC %

Variance

ICC %

Variance

ICC %

Variance

ICC %

Variance

ICC %

 Level 2 (GP)

0.441

11.7

0.345

9.4

0.252

7.1

0.556

14.3

0.370

9.8

0.498

12.8

 Level 3 (primary care subdistrict)

0.037

1.0

0.031

0.8

0.000

0.0

0.027

0.7

0.095

2.5

0.090

2.3

 Level 4 (healthcare district)

0.011

0.3

0.007

0.2

0.000

0.0

0.026

0.7

0.000

0.0

0.000

0.0

  1. Logistic regression adjusted odds ratio and 95% CI of overall inappropriateness of referral forms for each diagnostic procedure by patient, referral form and physician variables, and analysis of the variability in overall inappropriateness of referral forms between GPs, primary care subdistrict and healthcare districts. All referral forms made out by general practitioners in the province of Reggio Emilia, Italy, between 2012 and 2017 were included
  2. OR odds ratio, ICC interclass correlation coefficient
  3. a Model adjusted for 1st level covariates: Patient’s Age, Sex, Exemption, Year of prescription