Skip to main content

Table 3 Effects of compositional characteristics and quality indicators of provider networks on the risk of nursing home admission

From: Associations between quality of care in informal provider networks and nursing home admissions in Germany: results of a retrospective cohort study using German health claims data

 

Model 1: individual predictors

Model 2: composition and quality of care indicators

Model 3: individual predictors, composition and quality of care indicators

Hazard ratio [95% CI] adjusted for age, sex, level of care, individual predictors

Hazard ratio [95% CI] adjusted for age, sex, level of care

Hazard ratio [95% CI] adjusted for age, sex, level of care, individual predictors

Sex female (Reference male)

1.24* [1.21; 1.28]

1.21* [1.18; 1.24]

1.24* [1.21; 1.28]

Level of care none (Reference level of care 1)

0.19* [0.15; 0.23]

0.17* [0.13; 0.20]

0.19* [0.15; 0.23]

Level of care 2 (Reference level of care 1)

1.25* [1.22; 1.28]

1.99* [1.94; 2.03]

1.26* [1.23; 1.29]

Level of care 3 (Reference level of care 1)

0.86* [0.83; 0.90]

1.77* [1.71; 1.85]

0.86* [0.82; 0.89]

Age

1.06* [1.05; 1.06]

1.04* [1.04; 1.04]

1.06* [1.05; 1.06]

Composition of the provider network

   

 Composition: general practitioners

 

1.04 [0.91; 1.19]

1.01 [0.88; 1.16]

 Composition: ophthalmologists

 

1.18* [1.00; 1.38]

1.14 [0.97; 1.34]

 Composition: surgeons

 

1.14 [0.98; 1.32]

1.08 [0.94; 1.25]

 Composition: multidisciplinary practices

 

1.07 [0.94; 1.22]

1.04 [0.91; 1.19]

 Composition: therapists

 

1.08 [0.95; 1.24]

1.04 [0.91; 1.19]

 Composition: internists

 

1.10 [0.96; 1.26]

1.06 [0.93; 1.21]

 Composition: orthopaedics

 

1.06 [0.92; 1.24]

1.03 [0.89; 1.20]

 Composition: psychologists and psychotherapists

 

1.08 [0.94; 1.24]

1.04 [0.90; 1.19]

 Composition: other disciplines

 

1.08 [0.95; 1.24]

1.04 [0.91; 1.19]

 Composition: urologists

 

1.11 [0.94; 1.30]

1.07 [0.91; 1.26]

 Composition: rehabilitation facilities

 

0.97 [0.85; 1.12]

0.96 [0.83; 1.10]

 Composition: hospitals

 

1.01 [0.88; 1.16]

0.98 [0.86; 1.13]

 Composition: logarithm of number of providers in provider networks

 

1.06* [1.00; 1.13]

1.05 [0.99; 1.11]

 Composition: number of comorbidities

 

3.08* [1.36; 6.97]

2.95* [1.30; 6.68]

Quality of care indicators

   

 COC asthma

 

1.01* [1.00; 1.02]

1.01* [1.00; 1.02]

 SECON asthma

 

1.00 [0.99; 1.01]

1.00 [0.99; 1.00]

 UPC asthma

 

0.98* [0.96; 0.99]

0.98* [0.97; 0.99]

 COC COPD

 

0.88* [0.84; 0.93]

0.89* [0.84; 0.94]

 SECON COPD

 

1.06* [1.03; 1.08]

1.06* [1.03; 1.08]

 UPC COPD

 

1.12* [1.04; 1.20]

1.11* [1.03; 1.19]

 COC dementia

 

0.93* [0.89; 0.97]

0.93* [0.89; 0.97]

 SECON dementia

 

1.01 [0.99; 1.03]

1.01 [1.00; 1.03]

 UPC dementia

 

1.10* [1.04; 1.16]

1.10* [1.04; 1.16]

 COC T2D

 

1.18* [1.11; 1.25]

1.17* [1.11; 1.24]

 SECON T2D

 

0.96* [0.94; 0.98]

0.96* [0.94; 0.98]

 UPC T2D

 

0.84* [0.78; 0.89]

0.84* [0.78; 0.90]

 COC heart failure

 

0.98 [0.95; 1.00]

0.97* [0.95; 0.99]

 SECON heart failure

 

0.99 [0.98; 1.00]

0.99 [0.98; 1.00]

 UPC heart failure

 

1.05* [1.02; 1.08]

1.06* [1.03; 1.10]

 Asthma: prevalence

 

0.99 [0.95; 1.02]

0.99 [0.95; 1.02]

 Asthma: spirometry

 

1.00 [1.00; 1.00]

1.00 [1.00; 1.00]

 Asthma: inhalative medication

 

1.00 [1.00; 1.01]

1.00 [1.00; 1.01]

 Asthma: ICS

 

1.00 [1.00; 1.01]

1.00 [1.00; 1.01]

 Medication: PRISCUS

 

0.93* [0.91; 0.95]

0.92*[0.91; 0.94]

 Medication: beta-blocker after myocardial infarction

 

1.00 [0.99; 1.00]

0.99 [0.99; 1.00]

 Medication: ACE-inhibitor upon hypertension and renal insufficiency

 

1.00 [0.99; 1.01]

1.00 [0.99; 1.00]

 Medication: ACE-inhibitor upon heart failure

 

1.01* [1.00; 1.01]

1.01 [1.00; 1.01]

 Medication: beta-blocker upon asthma

 

1.01* [1.00; 1.02]

1.01* [1.00; 1.02]

 Medication: electrolyte check upon diuretics

 

1.00 [0.99; 1.01]

1.00 [0.99; 1.00]

 Medication: polypharmacy

 

1.01 [1.00; 1.03]

1.01 [0.99; 1.03]

 Ambulatory care sensitive hospital cases

 

0.98 [0.94; 1.02]

0.96 [0.92; 1.00]

 COPD: prevalence

 

0.99 [0.96; 1.01]

0.98 [0.96; 1.01]

 COPD: inhalative medication

 

1.02* [1.01; 1.03]

1.02* [1.01; 1.03]

 COPD: acute inpatient treatment

 

1.01 [0.99; 1.04]

1.01 [0.98; 1.03]

 COPD: respiratory therapy

 

0.99 [0.98; 1.00]

0.99 [0.98; 1.00]

 COPD: influenza vaccination

 

1.00 [0.99; 1.01]

1.00 [0.99; 1.01]

 COPD: specific beta-blocker therapy

 

0.98* [0.97; 0.99]

0.98* [0.98; 0.99]

 COPD: specific anticholinergic therapy

 

0.98* [0.97; 0.99]

0.98* [0.97; 0.99]

 COPD: oral corticosteroids

 

1.01* [1.00; 1.03]

1.02* [1.00; 1.03]

 CVD: prevalence hypertension

 

0.98 [0.97; 1.00]

0.99 [0.97; 1.00]

 CVD: medication for hypertension

 

0.98 [0.96; 1.01]

0.97 [0.95; 1.00]

 CVD: prevalence heart failure

 

1.04* [1.02; 1.06]

1.04* [1.02; 1.06]

 CVD: echocardiography upon heart failure

 

1.00 [1.00; 1.00]

1.00 [1.00; 1.00]

 CVD: 12-lead ECG upon heart failure

 

1.00 [1.00; 1.00]

1.00 [1.00; 1.00]

 CVD: ACE-inhibitor upon heart failure

 

1.00 [0.99; 1.00]

1.00 [0.99; 1.01]

 CVD: beta-blocker upon heart failure

 

1.00 [1.00; 1.01]

1.00 [1.00; 1.01]

 CVD: anticoagulant upon atrial fibrillation and heart failure

 

1.00* [0.99; 1.00]

1.00* [0.99; 1.00]

 CVD: referral to cardiologist upon heart failure

 

1.00* [1.00; 1.00]

1.00* [1.00; 1.00]

 CVD: acute inpatient treatment of heart failure

 

1.00 [1.00; 1.01]

1.00 [1.00; 1.01]

 CVD: apoplexy treatment in stroke unit

 

1.03* [1.01; 1.04]

1.03* [1.02; 1.05]

 CVD: platelet aggregation inhibitor upon stable chronic coronary heart disease

 

0.96* [0.95; 0.96]

0.95* [0.94; 0.96]

 CVD: statins upon coronary heart disease

 

1.01 [1.00; 1.02]

1.01 [1.00; 1.02]

 CVD: anti-hypertensive therapy upon coronary heart disease and hypertension

 

1.02* [1.00; 1.03]

1.02* [1.01; 1.04]

 Dementia: prevalence

 

0.93* [0.90; 0.95]

0.91* [0.88; 0.94]

 Dementia: B12 and TSH

 

1.00 [0.99; 1.00]

1.00 [0.99; 1.01]

 T2D: prevalence

 

0.96* [0.95; 0.97]

0.96* [0.95; 0.98]

 T2D: control of HbA1c

 

0.97* [0.97; 0.98]

0.97* [0.97; 0.98]

 T2D: ophthalmological examination

 

0.99* [0.98; 0.99]

0.99* [0.98; 0.99]

 T2D: fundus examination

 

0.99* [0.98; 1.00]

0.99* [0.98; 1.00]

 T2D: triglycerides and cholesterol

 

1.00* [1.00; 1.01]

1.00* [1.00; 1.01]

 T2D: hypertension, nephropathy and ACE-inhibitor or AT1-blocker

 

1.00 [1.00; 1.00]

1.00 [1.00; 1.00]

 T2D: control of serum-creatinine

 

1.03* [1.02; 1.03]

1.03* [1.02; 1.04]

 Osteoarthritis: prevalence

 

1.02* [1.00; 1.03]

1.02* [1.00; 1.04]

 Osteoporosis: prevalence

 

1.00 [0.98; 1.03]

1.01 [0.99; 1.03]

 Prevention: influenza vaccination

 

0.99 [0.98; 1.01]

1.00 [0.98; 1.01]

 Prevention: mammography

 

0.99* [0.99; 1.00]

0.99* [0.99; 1.00]

 Prevention: faecal occult blood test

 

1.12* [1.08; 1.16]

1.12* [1.09; 1.17]

 Prevention: men's cancer screening

 

0.98* [0.97; 0.99]

0.98* [0.97; 0.99]

 Prevention: skin-cancer screening

 

0.91* [0.87; 0.94]

0.90* [0.87; 0.93]

 Depression: prevalence

 

0.96* [0.94; 0.98]

0.96* [0.94; 0.98]

 Depression: anti-depressive pharmacotherapy

 

1.01* [1.00; 1.02]

1.01* [1.01; 1.02]

Model parameters

   

 R2

0.084

0.020

0.086

 AIC

733,624.5

774,180.5

732,212.3

 Random effects SD

0.320

0.375

0.374

 N (person-quarters under risk)

1,622,695

1,622,695

1,622,695

 Events (Nursing home admissions)

35,540

35,540

35,540

  1. *Significance level α = .05. CI, confidence interval; SD, standard deviation; COC, Continuity of Care Index; UPC, Usual Provider Index; SECON, Sequential Continuity of Care Index; T2D, type 2 diabetes mellitus; ICS, Inhalative Corticosteroids; PRISCUS, List of potential inadequate medication for the elderly; CVD, cardiovascular disease; COPD, chronic obstructive pulmonary disease; B12, Vitamin B12; TSH, Thyroid Stimulating Hormone; R2, R-squared; AIC, akaike information criterion