From: Exploring variation in low-value care: a multilevel modelling study
Variable | Statistic | Sentinel lymph node biopsy | Carotid endarterectomy | EVAR | Knee arthroscopy | ERCP | Abdominal hysterectomy | Spinal fusion | Colonoscopy | Endoscopy |
---|---|---|---|---|---|---|---|---|---|---|
Episode level | ||||||||||
Age group* | ||||||||||
1 | OR | 18–39: 0.2 | 18–74: 0.8 | 18–74: 0.5 | 54–64: 2.1 | 18–39: 0.5 | 18–39: 0.7 | 18–49: 0.5 | 18–29: 0.6 | 18–24: 0.4 |
(0.1–0.5) | (0.5–1.2) | (0.3–0.7) | (1.9–2.2) | (0.3–0.7) | (0.7–0.8) | (0.3–0.7) | (0.5–0.7) | (0.3–0.4) | ||
2 | OR | 40–54: 0.9 | 75–79: 1 | 75–79: 1 | 65–79: 1 | 40–54: 0.6 | 40–49: 1 | 50–64: 1 | 30–34: 0.6 | 25–34: 0.5 |
(0.6–1.3) | (0.4–0.8) | (0.5–0.7) | (0.5–0.5) | |||||||
3 | OR | 55–69: 1 | 80–84: 0.8 | 80–84: 1.5 | 70–79: 0.5 | 55–69: 1 | 50–59: 0.8 | 65–79: 1.0 | 35–44: 0.9 | 35–44: 0.7 |
(0.6–1.1) | (1.0–1.2) | (0.5–0.6) | (0.7–0.8) | (0.7–1.5) | (0.8–1.0) | (0.7–0.8) | ||||
4 | OR | 70–100: 0.8 | 85–99: 0.8 | 85–99: 0.9 | 80–110: 0.2 | 70–105: 1.9 | 60–95: 0.2 | 80–105: 0.1 | 45–49: 1 | 45–54: 1 |
(0.6–1.1) | (0.5–1.2) | (0.6–1.4) | (0.1–0.2) | (1.4–2.6) | (0.2–0.3) | (0.1–0.3) | ||||
Female | OR | 0.6 | 1.0 | 0.7 | 0.9 | 1.0 | 1.0 | 1.4 | 1.0 | |
(0.4–0.8) | (0.7–1.3) | (0.5–1.0) | (0.8–1.0) | (0.8–1.2) | (0.8–1.5) | (1.3–1.6) | (0.9–1.0) | |||
Charlson comorbidity index | ||||||||||
1 | OR | 1.2 | 0.5 | 0.9 | 0.7 | 0.7 | 1.1 | 0.7 | 0.4 | 0.5 |
(0.7–2.0) | (0.3–0.7) | (0.6–1.3) | (0.6–0.7) | (0.5–1.1) | (0.9–1.3) | (0.4–1.1) | (0.3–0.5) | (0.5–0.6) | ||
2–16 | OR | 0.8 | 0.3 | 0.8 | 0.2 | 1.0 | 1.8 | 0.2 | 0.3 | 0.2 |
(0.4–1.8) | (0.2–0.4) | (0.6–1.1) | (0.2–0.3) | (0.7–1.4) | (1.3–2.4) | (0.1–0.3) | (0.2–0.4) | (0.2–0.3) | ||
Private patient | OR | 1.8 | 1.2 | 1.0 | 0.5 | 2.4 | 1.2 | 0.2 | 0.6 | 0.6 |
(1.1–2.8) | (0.8–1.7) | (0.6–1.5) | (0.4–0.6) | (1.8–3.1) | (1.0–1.4) | (0.1–0.4) | (0.5–0.7) | (0.6–0.7) | ||
Financial year | OR | 1.1 | 1.1 | 1.1 | 0.9 | 1.0 | 0.9 | 1.0 | 1.0 | 1.0 |
(1.0–1.2) | (1.0–1.2) | (1.0–1.1) | (0.9–0.9) | (0.9–1.0) | (0.9–1.0) | (0.9–1.1) | (0.9–1.0) | (1.0–1.0) | ||
Hospital level | ||||||||||
Peer group | ||||||||||
B | OR | 0.4 | 2.5 | 1.0 | 1.1 | 0.6 | 0.8 | 0.4 | 1.1 | 1.2 |
(0.1–1.6) | (1.0–6.9) | (0.4–3.3) | (0.8–1.4) | (0.4–0.9) | (0.5–1.2) | (0.0–4.0) | (0.7–1.6) | (0.8–1.8) | ||
IOR80 | 0.1–2.7 | 0.6–11 | 0.5–2.2 | 0.1–13 | 0.4–0.9 | 0.2–2.6 | 0.1–3.5 | 0.4–3.0 | 0.4–4.0 | |
C1 | OR | 0.4 | 2.2 | 1.2 | 1.2 | 0.7 | ||||
(0.1–1.9) | (0.9–5.1) | (0.6–2.1) | (0.7–2.0) | (0.4–1.1) | ||||||
IOR80 | 0.1–2.5 | 0.2–28 | 0.4–3.9 | 0.4–3.3 | 0.2–2.3 | |||||
C2 | OR | 0.2 | 4.2 | 0.6 | 0.9 | 0.9 | ||||
(0.0–1.2) | (1.7–9.6) | (0.3–1.0) | (0.5–1.6) | (0.6–1.5) | ||||||
IOR80 | 0.0–1.1 | 0.3–52 | 0.2–1.8 | 0.3–2.6 | 0.3–3.0 | |||||
D1a | OR | 3.6 | 1.3 | 0.6 | ||||||
(0.9–13) | (0.5–2.9) | (0.3–1.2) | ||||||||
IOR80 | 0.3–45 | 0.5–3.5 | 0.2–2.0 | |||||||
D1b | OR | 0.9 | 0.6 | |||||||
(0.2–3.3) | (0.2–1.8) | |||||||||
IOR80 | 0.3–2.5 | 0.2–1.8 | ||||||||
Procedure as proportion total volume | OR | 1.3 | 4.2 | 3.4 | 1.1 | 4.5 | 1.0 | 1.2 | 1.1 | 1.1 |
(1.1–1.5) | (2.0–11.4) | (1.4–7.9) | (1.1–1.1) | (2.6–7.8) | (0.9–1.0) | (0.8–1.8) | (1.1–1.1) | (1.1–1.1) | ||
IOR80 | 0.2–8.5 | 1.0–19 | 1.6–7.2 | 0.1–14 | 2.9–7.1 | 0.3–3.3 | 0.1–11 | 0.4–3.0 | 0.3–3.6 | |
Variance | 1.1 | 0.7 | 0.2 | 2.0 | 0.1 | 0.4 | 1.5 | 0.3 | 0.4 | |
(0.4–2.4) | (0.3–1.4) | (0.0–0.5) | (1.4–2.8) | (0.0–0.2) | (0.3–0.7) | (0.5–3.8) | (0.2–0.5) | (0.3–0.6) | ||
VPC | 20 | 16 | 4.7 | 35 | 1.8 | 11 | 29 | 8.3 | 11 | |
MOR | 2.7 (1.8–4.3) | 2.2 (1.6–3.1) | 1.5 (1.2–1.9) | 3.8 (3.0–5.0) | 1.3 (1.1–1.6) | 1.9 (1.7–2.2) | 3.2 (2.0–6.5) | 1.7 (1.5–2.0) | 1.9 (1.7–2.1) | |
LHD level | ||||||||||
Rural | OR | 1.5 | 1.0 | 1.1 | 2.1 | 1.0 | 1.0 | 0.2 | 1.4 | 1.3 |
(0.4–7.3) | (0.3–4.3) | (0.4–2.8) | (0.7–6.2) | (0.5–1.9) | (0.6–1.9) | (0.0–2.0) | (0.9–2.3) | (0.7–2.2) | ||
IOR80 | 0.3–7.6 | 0.6–1.9 | 0.8–5.7 | 0.6–1.5 | 0.6–1.8 | 0.9–2.2 | 0.7–2.4 | |||
Variance | 0.8 | 0.1 | 0.3 | 0.1 | 0.1 | 0.1 | 0.1 | |||
(0.0–2.7) | (0.0–0.8) | (0.0–1.1) | (0.0–0.3) | (0.0–0.4) | (0.0–0.2) | (0.0–0.4) | ||||
VPC | 14 | 2.8 | 5.2 | 1.9 | 2.8 | 1.6 | 2.9 | |||
MOR | 2.3 (1.2–4.3) | 1.4 (1.0–2.3) | 1.7 (1.1–2.7) | 1.3 (1.0–1.7) | 1.4 (1.1–1.8) | 1.3 (1.0–1.6) | 1.4 (1.1–1.8) | |||
SLA level | ||||||||||
IRSAD quintile | ||||||||||
2 | OR | 0.6 | 1.1 | 0.8 | 1.2 | 1.0 | 1.0 | 0.7 | 1.0 | 0.9 |
(0.3–1.1) | (0.7–1.7) | (0.5–1.3) | (1.0–1.4) | (0.7–1.5) | (0.9–1.1) | (0.4–1.3) | (0.7–1.3) | (0.8–1.1) | ||
IOR80 | 0.2–1.8 | 0.6–2.0 | 0.5–1.2 | 0.7–2.0 | 0.6–1.6 | 0.8–1.2 | 0.2–2.1 | 0.5–2.0 | 0.5–1.8 | |
3 | OR | 0.9 | 1.2 | 1.1 | 1.2 | 0.9 | 0.9 | 0.4 | 1.2 | 1.0 |
(0.4–1.6) | (0.7–2.1) | (0.7–2.1) | (0.9–1.4) | (0.5–1.5) | (0.8–1.1) | (0.2–0.9) | (0.8–1.6) | (0.8–1.2) | ||
IOR80 | 0.3–2.5 | 0.6–2.2 | 0.7–1.8 | 0.7–2.0 | 0.5–1.5 | 0.8–1.1 | 0.1–1.2 | 0.6–2.4 | 0.5–1.8 | |
4 | OR | 1.0 | 1.4 | 0.6 | 1.2 | 1.2 | 1.0 | 0.4 | 1.0 | 0.9 |
(0.5–2.0) | (0.8–2.5) | (0.4–1.1) | (0.9–1.5) | (0.7–1.9) | (0.8–1.2) | (0.2–0.9) | (0.7–1.4) | (0.7–1.2) | ||
IOR80 | 0.3–2.8 | 0.7–2.6 | 0.4–1.0 | 0.7–2.0 | 0.7–1.9 | 0.8–1.2 | 0.1–1.3 | 0.5–2.0 | 0.5–1.7 | |
5 | OR | 0.7 | 1.3 | 1.0 | 1.3 | 1.4 | 1.0 | 0.6 | 0.9 | 0.9 |
(0.3–1.4) | (0.7–2.5) | (0.5–1.9) | (1.0–1.7) | (0.8–2.4) | (0.8–1.2) | (0.2–1.3) | (0.6–1.3) | (0.7–1.2) | ||
IOR80 | 0.2–1.9 | 0.7–2.4 | 0.6–1.6 | 0.8–2.2 | 0.8–2.2 | 0.8–1.2 | 0.2–1.8 | 0.4–1.9 | 0.5–1.6 | |
Remoteness category | ||||||||||
Inner Regional | OR | 2.5 | 0.6 | 0.9 | 0.7 | 1.5 | 1.1 | 3.8 | 1.0 | 1.3 |
(1.4–4.7) | (0.4–1.0) | (0.5–1.4) | (0.6–0.9) | (0.9–2.5) | (0.9–1.3) | (2.0–6.7) | (0.8–1.4) | (1.0–1.6) | ||
IOR80 | 0.9–7.1 | 0.3–1.1 | 0.5–1.4 | 0.4–1.2 | 0.9–2.4 | 0.9–1.3 | 1.2–12 | 0.5–2.2 | 0.7–2.3 | |
Outer Regional | OR | 2.9 | 0.7 | 1.8 | 0.7 | 1.9 | 1.2 | 2.9 | 1.6 | 1.7 |
(1.1–6.9) | (0.4–1.4) | (0.8–4.4) | (0.5–0.9) | (1.0–4.2) | (1.0–1.6) | (0.9–7.5) | (1.1–2.4) | (1.2–2.4) | ||
IOR80 | 1.0–8.4 | 0.4–1.3 | 1.1–2.9 | 0.4–1.2 | 1.2–3.2 | 1.0–1.5 | 0.9–9.1 | 0.8–3.3 | 0.9–3.1 | |
Remote/Very remote | OR | 0.6 | 1.0 | 3.3 | 0.9 | 1.6 | ||||
(0.3–1.3) | (0.6–1.6) | (0.2–30) | (0.3–2.4) | (0.8–3.0) | ||||||
IOR80 | 0.4–1.1 | 0.8–1.2 | 1.1–10.5 | 0.4–1.8 | 0.8–2.9 | |||||
Population prevalence of indication | OR | 1.1 | 1.3 | 0.9 | 1.0 | 1.1 | 0.7 | 0.9 | 0.9 | |
(0.3–4.4) | (0.5–3.0) | (0.4–1.9) | (0.9–1.1) | (0.9–1.3) | (0.5–1.1) | (0.9–1.0) | (0.8–1.0) | |||
IOR80 | 0.4–3.3 | 0.7–2.4 | 0.5–1.4 | 0.6–1.7 | 0.7–1.7 | 0.2–2.3 | 0.4–1.9 | 0.5–1.7 | ||
Variance | 0.3 | 0.1 | 0.1 | 0.1 | 0.1 | 0.0 | 0.4 | 0.2 | 0.1 | |
(0.1–0.8) | (0.0–0.3) | (0.0–0.3) | (0.1–0.1) | (0.0–0.2) | (0.0–0.0) | (0.1–0.8) | (0.1–0.2) | (0.1–0.2) | ||
VPC | 6.2 | 2.8 | 2.0 | 1.5 | 2.1 | 0.3 | 7.7 | 4.3 | 2.9 | |
MOR | 1.7 (1.3–2.3) | 1.4 (1.1–1.7) | 1.3 (1.0–1.6) | 1.3 (1.3–1.4) | 1.3 (1.0–1.6) | 1.1 (1.0–1.2) | 1.8 (1.4–2.4) | 1.5 (1.4–1.6) | 1.4 (1.3–1.5) |