Table 2

Association of Social Complexity Factors With Indicators of the Quality of Primary Care

Quality IndicatorLikelihood of Receipt, Odds Ratio (99% CI)aP Valueb
1 Factor2 Factors3 Factors4 Factors≥5 Factors
Prevention and screening
 Breast cancer screening (women 50–74 y)0.77 (0.73–0.81)0.54 (0.50–0.58)0.38 (0.34–0.42)0.28 (0.24–0.33)0.22 (0.18–0.27)<.001
 Cervical cancer screening (women 21–69 y)1.04 (1.00–1.08)0.96 (0.92–1.01)0.87 (0.81–0.92)0.94 (0.87–1.02)1.01 (0.93–1.09).003
 Colorectal cancer screening (adults 50–74 y)0.83 (0.80–0.86)0.66 (0.63–0.70)0.51 (0.47–0.56)0.40 (0.35–0.46)0.36 (0.30–0.44).001
 Completed vaccinations at 2 y0.70 (0.61–0.81)0.55 (0.46–0.66)0.41 (0.33–0.50)0.33 (0.26–0.43)0.26 (0.19–0.36)<.001
 Annual influenza vaccination (adults ≥65 y)0.88 (0.83–0.93)0.74 (0.68–0.82)0.69 (0.59–0.81)0.68 (0.52–0.89)1.17 (0.76–1.79)<.001
 Annual influenza vaccination (total respiratory morbidity)0.84 (0.80–0.87)0.75 (0.70–0.79)0.74 (0.69–0.80)0.67 (0.61–0.74)0.64 (0.58–0.71).02
 Pneumococcal vaccination (adults ≥65 y)0.95 (0.90–1.01)0.88 (0.80–0.97)0.90 (0.76–1.07)0.90 (0.69–1.18)0.90 (0.59–1.39).001
Chronic disease management
 Diabetes management: eye examination0.86 (0.79–0.92)0.78 (0.70–0.87)0.70 (0.61–0.82)0.69 (0.58–0.84)0.52 (0.42–0.64)<.001
 CHF management: initiation of ACE inhibitor0.90 (0.73–1.11)0.72 (0.53–0.99)0.80 (0.50–1.29)0.59 (0.32–1.09)0.41 (0.19–0.88)<.001
 CHF management: persistence of ACE inhibitor0.85 (0.69–1.05)0.77 (0.56–1.05)0.63 (0.39–1.01)0.74 (0.40–1.36)0.27 (0.11–0.63).045
 Post-MI management: initiation of β-blocker1.16 (0.76–1.77)0.80 (0.45–1.43)0.96 (0.39–2.37)0.30 (0.12–0.76)0.48 (0.14–1.67).04
 Post-MI management: persistence of β-blocker0.97 (0.72–1.31)0.77 (0.50–1.19)0.75 (0.40–1.39)0.66 (0.29–1.52)0.94 (0.34–2.66).65
 Post-MI management: initiation of statin0.87 (0.64–1.17)0.81 (0.52–1.25)0.63 (0.34–1.19)0.43 (0.19–0.98)0.91 (0.31–2.69).02
 Post-MI management: persistence of statin0.75 (0.56–1.01)0.76 (0.49–1.16)0.49 (0.26–0.92)0.46 (0.20–1.05)0.82 (0.30–2.24).004
 Asthma management: medication use0.90 (0.82–0.99)0.90 (0.80–1.01)0.81 (0.71–0.94)0.81 (0.69–0.96)0.88 (0.75–1.04).001
Medications
 Benzodiazepine prescription (community-dwelling adults ≥75 y)1.63 (1.48–1.80)2.16 (1.82–2.56)3.15 (2.25–4.40)3.03 (1.36–6.71)3.08 (0.68–14.00)<.001
 Beers List drug prescription (community-dwelling adults ≥65 y)1.39 (1.31–1.47)1.92 (1.74–2.12)2.37 (2.01–2.79)3.50 (2.67–4.60)4.05 (2.61–6.28)<.001
 Depression care: prescription follow-up1.07 (0.90–1.28)1.09 (0.88–1.35)1.09 (0.83–1.42)1.21 (0.89–1.64)1.46 (1.08–1.99).004
Health services use
 Hospitalizations for ACSC (adults ≥74 y)1.43 (1.11–1.84)2.40 (1.77–3.24)3.58 (2.52–5.08)4.80 (3.24–7.11)5.64 (3.70–8.60)<.001
 Radiograph for low back pain (adults ≥20 y)0.92 (0.73–1.15)1.02 (0.76–1.37)0.80 (0.54–1.18)0.83 (0.50–1.37)1.10 (0.68–1.80).34
 Hospital episodes with readmission within 30 d1.23 (1.11–1.36)1.41 (1.25–1.60)1.86 (1.62–2.15)1.91 (1.63–2.24)2.21 (1.89–2.58)<.001
 ED visits for low-acuity (CTAS 4 and 5c) patients1.21 (1.17–1.24)1.54 (1.50–1.60)2.02 (1.95–2.10)2.61 (2.51–2.72)3.38 (3.24–3.51)<.001
 Ambulatory visits to primary care1.09 (1.08–1.09)1.19 (1.19–1.20)1.29 (1.28–1.29)1.41 (1.40–1.42)1.62 (1.61–1.62).001
 Ambulatory visits for patients with RUB of 3, 4, or 51.11 (1.09–1.13)1.26 (1.23–1.29)1.44 (1.36–1.51)1.70 (1.55–1.86)2.12 (1.88–2.39)<.001
 Ambulatory visits with a call to health telephone service within 2 d of visit1.02 (0.97–1.06)1.14 (1.08–1.20)1.33 (1.25–1.42)1.53 (1.43–1.64)1.75 (1.63–1.87)<.001

  • ACE = angiotensin-converting enzyme; ACSC = ambulatory care–sensitive conditions; CHF = congestive heart failure; CTAS = Canadian Triage Acuity Scale; ED = emergency department; MI = myocardial infarction; RUB = resource utilization band.

  • Note: Adjusted for sex, age, income quintile, and morbidity level (RUB).

  • ↵a Compared with patients having no social complexity factors.

  • ↵b For trend across factor categories.

  • ↵c On a scale of 1 to 5, with 5 being lowest acuity.