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Table 7 Adjusted multilevel regression analysis of health centre and patient level factors on delivery of guideline scheduled Type 2 diabetes services (n = 10,674 clients; 132 health centres)

From: Duration of participation in continuous quality improvement: a key factor explaining improved delivery of Type 2 diabetes services

Outcome is >76% service delivery

Empty Model A

Model B

Model C

Predictors

Fixed effects

OR

95% CI

OR

95% CI

OR

95% CI

Audit Year

2005/2006

1.00

(reference)

1.00

(reference)

1.00

(reference)

 

2007

1.62

(1.32-1.98)***

1.14

(0.91-1.44)

1.20

(0.95-1.51)

 

2008

1.90

(1.57-2.32)***

1.21

(0.95-1.54)

1.30

(1.02-1.67)*

 

2009

2.41

(1.99-2.93)***

1.35

(1.03-1.77)*

1.40

(1.07-1.83)*

 

2010

2.23

(1.80-2.76)***

1.16

(0.86-1.57)

1.17

(0.86-1.59)

 

2011

2.40

(1.97-2.93)***

1.25

(0.92-1.71)

1.24

(0.91-1.69)

 

2012

2.89

(2.37-3.53)***

1.18

(0.82-1.68)

1.17

(0.82-1.67)

Health Centre Characteristics

      

Location X duration of CQI participation

      

Non-remote:

Baseline

  

1.00

(reference)

1.00

(reference)

 

1-2 cycles

  

1.53

(1.10-2.11)*

1.47

(1.06-2.04)*

 

≥3 cycles

  

1.62

(1.02-2.55)*

1.55

(0.98-2.45)

Remote:

Baseline

  

1.00

(reference)

1.00

(reference)

 

1-2 cycles

  

2.92

(1.36-6.24)**

2.91

(1.36-6.22)**

 

≥3 cycles

  

3.14

(1.37-7.18)**

3.29

(1.44-7.54)**

Very Remote:

Baseline

  

1.00

(reference)

1.00

(reference)

 

1-2 cycles

  

4.03

(2.27-7.16)***

4.31

(2.43-7.67)***

 

≥3 cycles

  

4.72

(2.47-9.02)***

5.05

(2.63-9.67)***

Patient attendance in last 6 months

Lower attendance

  

1.00

(reference)

1.00

(reference)

Higher attendance

  

1.40

(1.22-1.60)***

1.40

(1.22-1.61)***

Patient Characteristics (Age X disease status)

    

≥15- <-25 years: Comorbidity

One condition

    

1.00

(reference)

2 or more conditions

    

1.83

(0.85-3.94)

≥15- <-25 years: Complications

None

    

1.00

(reference)

1-2 complications

    

0.87

(0.13-5.68)

 

>2 complications

    

5.82

(0.45-74.5)

≥25- <-40 years: Comorbidity

One condition

    

1.00

(reference)

2 or more conditions

    

1.38

(1.10-1.73)**

≥25- <-40 years: Complications

None

    

1.00

(reference)

1-2 complications

    

2.40

(1.53-3.77)***

 

>2 complications

    

1.73

(0.72-4.13)

≥40- <-55 years: Comorbidity

One condition

    

1.00

(reference)

2 or more conditions

    

1.43

(1.20-1.69)***

≥40- <-55 years: Complications

None

    

1.00

(reference)

1-2 complications

    

1.32

(1.05-1.65)*

 

>2 complications

    

1.17

(0.80-1.70)

≥55 years: Comorbidity

One condition

    

1.00

(reference)

2 or more conditions

    

1.26

(1.05-1.52)*

≥55 years: Complications

None

    

1.00

(reference)

1-2 complications

    

1.29

(1.05-1.58)*

 

>2 complications

    

1.45

(1.04-2.01)*

Random effects (intercepts)

      

State (variance (SE))

1.41

(0.99)

0.72

(0.53)

0.69

(0.51)

 

MOR STATE

3.10

 

2.24

 

2.21

 

PCV (% explained variance)

  

49%

 

51%

 

Health Centre (variance (SE))

1.21

(0.19)

0.93

(0.15)

0.94

(0.15)

 

MOR HC

2.86

 

2.51

 

2.52

 

PCV (% explained variance)

  

23%

 

23%

 

State & Health Centre (variance)

2.62

 

1.65

 

1.63

 
 

MOR STATE-HC

4.68

 

3.41

 

3.38

 

PCV (% explained variance)

  

37%

 

38%

 

Patient (variance (SE))

0.13

(0.072)

0.07

(0.03)

0.02

(0.012)

PCV (% explained variance)

  

44%

 

81%

 
  1. *p <-0.05; **p <-0.01; ***p <-0.0001.
  2. MOR (Median odds ratio): odds of receiving `top quartile service delivery’ if a patient was to change health centre or jurisdiction [17].
  3. PCV (Proportional change in variance): percent variation explained in odds for better health care delivery by introduction of health centre or patient level factors [16].
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BMC Health Services Research

ISSN: 1472-6963

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