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Table 4 Multivariable analyses for the decision to refer vignette patients (n = 680 decisions)

From: Patient and provider determinants of nephrology referral in older adults with severe chronic kidney disease: a survey of provider decision making

 

Model 1

OR

(95% CI)

P value

Model 2

OR

(95% CI)

P value

Model 3

OR

(95% CI)

P value

Patient Characteristic

      

Older Age

0.32

(0.20 to 0.51)

< 0.001*

0.28

(0.17 to 0.47)

< 0.001*

0.27

(0.15 to 0.48)

< 0.001*

Female gender

1.10

(0.70 to 1.72)

0.68

0.92

(0.57 to 1.46)

0.71

0.91

(0.55 to 1.50)

0.72

Black race

1.29

(0.83 to 2.03)

0.26

1.33

(0.83 to 2.12)

0.24

1.46

(0.89 to 2.41)

0.14

Presence of Stage III CHF

1.03

(0.66 to 1.61)

0.90

1.03

(0.65 to 1.64)

0.91

1.00

(0.60 to 1.68)

1.00

Ambulates with walker

0.83

(0.53 to 1.30)

0.42

0.85

(0.54 to1.36)

0.51

0.89

(0.54 to 1.46)

0.66

Presence of moderate dementia

0.16

(0.10 to 0.27)

< 0.001*

0.16

(0.09 to 0.27)

< 0.001*

0.14

(0.07 to 0.25)

< 0.001*

PCP Demographics

      

Older Age

  

1.04

(1.01 to 1.06)

< 0.001

1.03

(0.97 to 1.09)

0.29

Non-white race

  

3.65

(1.67 to 7.95)

0.001*

30.29

(1.30 to 703.73)

0.03*

Female gender

  

3.42

(2.11 to 5.58)

< 0.001*

7.75

(2.07 to 28.93)

0.002*

OKPRN

  

0.60

(0.38 to 0.93)

0.02

0.33

(0.06 to 1.87)

0.21

Urban practice

  

1.10

(0.77 to 1.59)

0.60

0.64

(0.24 to 1.710

0.38

Foreign Medical School Graduate

  

1.09

(0.71 to 1.67)

0.69

1.80

(0.33 to 9.78)

0.50

PCP Experience

      

Estimation of Remaining Life Expectancy

    

0.99

(0.90 to 1.09)

0.73

Report of knowledge of KDOQI guidelines

    

1.09

(0.30 to 3.98)

0.89

Importance of Patient Age

    

1.12

(0.20 to 6.23)

0.89

Importance of Patient Race

    

0.01

(0.00 to 0.31)

0.01

Importance of Patient Functional Status

    

1.28

(0.36 to 4.56)

0.70

Importance of Patient Cognitive Status

    

0.33

(0.08 to 1.25)

0.10

Importance of Severity of CKD

    

17.43

(4.90 to 61.93)

< 0.001*

Importance of Co-morbidities

    

0.22

(0.07 to 0.77)

0.02*

Majority of patients over age 65

    

1.07

(0.38 to 3.00)

0.89

More than 10 patients referred to nephrology in last 1 year

    

4.21

(1.54 to 11.48)

0.01*

PCP Expectations of Referral

      

Expectation that nephrologist would evaluate etiology of CKD

    

2.16

(0.14 to 32.82)

0.58

Expectation that nephrologist would manage blood pressure

    

0.92

(0.33 to 2.58)

0.88

Expectation that nephrologist would treat anemia

    

0.28

(0.09 to 0.89)

0.03*

Expectation that nephrologist would discuss prognosis

    

0.20

(0.01 to 7.88)

0.39

Expectation that nephrologist would discuss initiation of dialysis

    

1.09

(0.10 to 12.40)

0.94

Expectation that nephrologist would discuss goals of care

    

53.13

(2.42 to 1168.00)

0.01*

PCP Risk and Uncertainty

      

Anxiety about uncertainty

    

1.28

(1.04 to 1.57)

0.02*

Concern about bad outcomes

    

0.81

(0.67 to .97)

0.03*

Reluctance to disclose uncertainty to patients

    

0.92

(0.72 to 1.18)

0.50

Reluctance to disclose uncertainty to other providers

    

0.95

(0.73 to 1.25)

0.73

Risk aversion

    

3.39

(1.02 to 11.24)

0.05*

  1. Sequential, random effects, multivariate logistic regression models were used to test the independent association of patient characteristics (Model 1), provider demographics (Model 2), and other provider characteristics including experience, expectations, disease-specific knowledge, risk aversion and uncertainty preferences (Model 3) with the decision to refer. Each model had new variables added as a block.
  2. * Values significant to p < 0.05