Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan

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Figure 1.
Participant flowchart.
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Figure 2.
Association between the overall measure of primary care attributes and hospitalization.
EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool; Q = quartile.
Notes: Association assessed by the JPCAT total score. Adjusted for age, sex, educational level, number of chronic conditions, and EQ-5D-5L. Error bars indicate 95% CIs. JPCAT total score quartiles: Q1, 0.0-35.4; Q2, 35.4-47.9; Q3, 47.9-60.4; Q4, 60.4-100.0.

Table 1.

Participant Characteristics at Baseline

Characteristic	Total (N = 1,161)	Non-Hospitalized (n = 1,074)	Hospitalized (n = 87)	Lost to Follow-Up (n = 101)
Age, mean (SD), y Sex, No. (%)	57.8 (10.3)	57.5 (10.2)	62.4 (9.9)	53.6 (10.2)
Male	566 (48.8)	514 (47.9)	52 (59.8)	49 (48.5)
Educational level, No. (%)
Bachelor’s degree or higher	528 (45.5)	492 (45.8)	36 (41.4)	38 (37.6)
Data missing	24 (2.1)	23 (2.1)	1 (1.1)	5 (5.0)
Number of chronic conditions, mean (SD)	1.2 (1.3)	1.2 (1.3)	1.9 (1.6)	1.0 (1.1)
Data missing, No. (%)	36 (3.1)	33 (3.1)	3 (3.4)	10 (9.9)
EQ-5D-5L, mean (SD)	0.89 (0.08)	0.89 (0.08)	0.83 (0.14)	0.88 (0.10)
Data missing, No. (%)	5 (0.4)	4 (0.4)	1 (1.1)	0 (0.0)
Usual source of care, No. (%)
Yes	723 (62.3)	671 (62.5)	52 (59.8)	57 (56.4)
JPCAT scores, mean (SD)^{^a}
Total score Domain scores	47.5 (17.0)	47.6 (16.9)	45.5 (17.8)	45.2 (19.5)
First contact	34.3 (26.3)	34.3 (26.4)	33.4 (25.9)	29.6 (27.2)
Longitudinality	57.0 (25.2)	57.2 (25.1)	54.6 (26.5)	52.9 (29.9)
Coordination	56.1 (30.6)	56.2 (30.3)	54.9 (34.3)	52.0 (34.6)
Comprehensiveness (services available)	51.1 (26.3)	51.1 (26.3)	50.5 (26.0)	51.8 (30.7)
Comprehensiveness (services provided)	36.3 (32.0)	36.6 (32.3)	31.6 (26.4)	32.0 (30.9)
Community orientation	50.1 (19.7)	50.2 (19.8)	48.8 (18.9)	52.9 (20.0)

EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool.
↵a Participants who have usual source of care.

Table 2.

Hospitalization by JPCAT Domain Scores^{^a} (N = 1,161)

JPCAT scores	JPCAT Domains, aOR (95% CI)
JPCAT scores	First Contact	Longitudinality	Coordination	Comprehensiveness (Services Available)	Comprehensiveness (Services Provided)	Community Orientation
No usual source of care	ref	ref	ref	ref	ref	ref
Q1	0.64 (0.30-1.36)	0.97 (0.46-2.02)	0.62 (0.30-1.28)	0.68 (0.34-1.35)	0.40 (0.19-0.84)^{^b}	0.45 (0.21-0.99)^{^b}
Q2	0.44 (0.09-2.23)	0.34 (0.16-0.73)^{^b}	0.49 (0.25-0.94)^{^b}	0.17 (0.03-0.89)^{^b}	0.80 (0.26-2.49)	0.39 (0.11-1.40)
Q3	0.47 (0.24-0.90)^{^b}	0.60 (0.26-1.38)	0.36 (0.14-0.95)^{^b}	0.55 (0.30-1.03)	0.70 (0.39-1.26)	0.65 (0.36-1.18)
Q4	0.49 (0.26-0.93)^{^b}	0.42 (0.22-0.82)^{^b}	0.45 (0.22-0.92)^{^b}	0.47 (0.23-0.97)^{^b}	0.24 (0.10-0.56)^{^b}	0.32 (0.15-0.68)^{^b}

aOR = adjusted odds ratio; EQ-5D-5L = 5-level version of the EuroQol 5-dimensional questionnaire; JPCAT = Japanese version of Primary Care Assessment Tool; Q = quartile.
Notes: First contact score quartiles: Q1, 0.0-12.5; Q2, 12.5-25.0; Q3, 25.0-50.0; Q4, 50.0-100.0.
Longitudinality score quartiles: Q1, 0.0-37.5; Q2, 37.5-62.5; Q3, 62.5-75.0; Q4, 75.0-100.0.
Coordination score quartiles: Q1, 0.0-50.0; Q2, 50.0; Q3, 50.0-87.5; Q4, 87.5-100.0.
Comprehensiveness (services available) score quartiles: Q1, 0.0-37.5; Q2, 37.5-50.0; Q3, 50.0-75.0; Q4, 75.0-100.0.
Comprehensiveness (services provided) score quartiles: Q1, 0.0; Q2, 0.0-25.0; Q3, 25.0-62.5; Q4, 62.5-100.0.
Community orientation score quartiles: Q1, 0.0-37.5; Q2, 37.5-50.0; Q3, 50.0-62.5; Q4, 62.5-100.0.
↵a Adjusted for age, sex, educational level, number of chronic conditions, and EQ-5D-5L.
↵b Significant difference, P <.05