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