Physician (N = 30) and Practice Characteristics by Panels’ Pneumococcal Polysaccharide Vaccine and Influenza Vaccination Rates, with Significance Testing by Hierarchical Linear Modeling
| PPV Vaccination | Influenza Vaccination | |||||
|---|---|---|---|---|---|---|
| Characteristics | High Ratea n=15 Panels | Low Ratea n=15 Panels | HLMPValueb | High Ratea n=15 Panels | Low Ratea n=15 Panels | HLMPValueb |
| EMR = electronic medical record; HLM = hierarchal linear modeling; LPN = licensed practical nurse; MA = medical assistant; PA =physician’s assistant; PPV = pneumococcal polysaccharide vaccine; Ref = reference group; RN = registered nurse. | ||||||
| a Median split, high-rate PPV = 65.5%–94.7% vaccinated; low-rate PPV = 11.3%–64.6% vaccinated; high-rate influenza = 52.7%–96.1% vaccinated; low-rate influenza = 22.4%–52.6% vaccinated. | ||||||
| b P value for the coefficient γ01 in weighted univariate HLM analyses, n = 30. | ||||||
| c US medical school, conference attendance, reads top tier research journals, board certified. | ||||||
| d PPV knowledge/support score applies to PPV and influenza knowledge/support score applies to influenza vaccination. | ||||||
| e See Supplemental Appendix 1, available at http://www.annfammed.org/cgi/content/full/7/6/534/DC1. | ||||||
| f Culture scores based on the Competing Values Framework8,9 to assess teamwork, innovation, bureaucracy, and efficiency. | ||||||
| Physician demographics | ||||||
| Solo physician, % | 20.0 | 26.7 | .190 | 20 | 26.7 | .682 |
| Ref = multiphysician practices | ||||||
| White, % | 73.3 | 53.3 | .386 | 60 | 66.7 | .511 |
| Ref = minority | ||||||
| Physicians who graduated from medical school 1982 to present, % | 60.0 | 60.0 | .991 | 40 | 80 | .034 |
| Ref = before 1982 | ||||||
| Higher physician education,c mean (SD), % | 5.8 (1.1) | 5.4 (0.9) | .186 | 5.7 (1.1) | 5.5 (0.9) | .539 |
| Immunization support | ||||||
| Using reminder cards/computer recall/ telephone call for patient preventive services, % | 66.7 | 66.7 | .568 | 73.3 | 60 | .122 |
| Ref = other nonsystematic methods | ||||||
| Offices where someone routinely screens for adult immunization, % | 40.0 | 26.7 | .477 | 53.3 | 13.3 | .010 |
| Offices with provider reminders for adult immunizations, % | 46.7 | 33.3 | .626 | 40 | 60 | .052 |
| Practices with standing orders for nurses to give adult immunizations without a doctor’s order, % | 26.7 | 6.7 | .216 | 33.3 | 0 | .000 |
| Offices with EMR, health maintenance/flow sheet to record adult immunizations, % | 46.7 | 53.3 | .064 | 60 | 40 | .171 |
| Ref = chart notes, vaccine log, sticker | ||||||
| Higher knowledge/more supportive of PPV (influenza) vaccinationd | 60.0 | 46.7 | .798 | 53.3 | 40 | .649 |
| Ref = lower | ||||||
| Physicians who received influenza vaccine in 2004–2005 season, % | 93.3 | 80.0 | .868 | 93.3 | 80 | .057 |
| Office structure/practice acuity | ||||||
| Time usual primary helper is RN, LPN, PA, % | 53.3 | 26.7 | .388 | 40 | 40 | .142 |
| Ref = MA, student | ||||||
| Patients’ bills coded 99213, mean (SD), % | 53.6 (20.2) | 53.2 (21.7) | .362 | 54.5 (18.5) | 52.3 (23.2) | .583 |
| Patients’ bills coded 99214, mean (SD), % | 39.1 (18.7) | 33.5 (22.4) | .171 | 37.3 (18.6) | 35.3 (22.8) | .663 |
| Physician estimate of time spent with adults for acute and chronic office visits, mean (SD), min | 18.2 (5.5) | 19.2 (4.6) | .498 | 19.3 (5) | 18.2 (5.2) | .522 |
| Physician estimate of time spent with adults for a well visit, mean (SD), min | 29.7 (10.43) | 26.8 (8.0) | .009 | 28.2 (11.4) | 28.3 (6.9) | .654 |
| Average observed time for total visit, mean (SD), min | 55.6 (20.1) | 47.6 (11.4) | .056 | 48.3 (9) | 54.9 (21.6) | .301 |
| Average observed time with physician in examination room—all types of visits, mean (SD), min | 15.3 (6.0) | 12.6 (5.6) | .158 | 15.4 (6.9) | 12.5 (4.4) | .068 |
| Better adaptability to office change, mean (SD), % | 8.9 (2.2) | 9.8 (1.8) | .420 | 9.7 (2.3) | 9.1 (1.8) | .704 |
| Greater office stability,e mean (SD), % | 8.9 (1.6) | 8.7 (1.7) | .810 | 9.1 (1.6) | 8.5 (1.6) | .468 |
| Hierarchical culture,f mean (SD), % | 23.4 (15.4) | 20.8 (12.8) | .993 | 16.3 (10.9) | 27.9 (14.5) | .018 |
| Group culture,f mean (SD), % | 44.8 (13.1) | 44.6 (14.2) | .488 | 43.3 (12.1) | 46.1 (14.3) | .310 |