Multilevel Modelling for Public Health and Health Services Research

Leyland, Alastair H.; Groenewegen, Peter

doi:10.1007/978-3-030-34801-4

Cited by 99 publications

(76 citation statements)

References 77 publications

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“…This allows to examine simultaneously the effects of predictors at group-and at individual-levels, in order to account for the non-independence of observations within groups. It allows to examine both variation between individuals and between groups [43,44]. With regard to the basic demographic characteristics age and gender, the study populations of GPs were representative of GPs in the respective countries [30].…”

Section: Discussionmentioning

confidence: 99%

Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries

et al. 2020

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Background: The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care thus achieving a higher quality of care and ensuring physicians' and patients' satisfaction. However, this communication is often not carried out properly. The objective of this study is to assess whether communication between GPs and medical specialists in the referral process is associated with the organisation of primary care within a country, the characteristics of the GPs, and the characteristics of the primary care practices themselves. Methods: An analysis of a cross-sectional survey among GPs in 34 countries was conducted. The odds ratios of the features that were expected to relate to higher rates of referral letters sent and communications fed back to GPs were calculated using ordered logistic multilevel models. Results: A total of 7183 GPs from 34 countries were surveyed. Variations between countries in referral letters sent and feedback communication received did occur. Little of the variance between countries could be explained. GPs stated that they send more referral letters, and receive more feedback communications from medical specialists, in countries where they act as gatekeepers, and when, in general, they interact more with specialists. GPs reported higher use of referral letters when they had a secretary and/or a nurse in their practice, used health information technologies, and had greater job satisfaction. Conclusions: There are large differences in communication between GPs and medical specialists. These differences can partly be explained by characteristics of the country, the GP and the primary care practice. Further studies should also take the organisation of secondary care into account.

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Section: Discussionmentioning

confidence: 99%

Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries

et al. 2020

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“…52 Multi-level modelling allows the analysis of individual-level outcomes in relation to variables at the same or higher levels and to split up the total variation in an outcome variable into parts that are attributable to the different levels. 53 Multi-level, multivariable logistic regression models were constructed in order to explain variations in patient enablement between patients, practices/GPs and countries, and to find significant factors associated with lower enablement. The modelling strategy is presented in Figure 2.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…54,55 The MOR is comparable with individual-level ORs and thus helps to quantify the extent of clustering. 55 As the number of higher-level variables should not exceed 10% of the number of higher-level units, 53 only three country-level variables could be included simultaneously in the final model. Missing values were excluded from the analyses.…”

Section: Statistical Analysesmentioning

confidence: 99%

Patient enablement after a consultation with a general practitioner—Explaining variation between countries, practices and patients

Tolvanen

Groenewegen

Koskela

et al. 2020

Health Expectations

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Background Patient enablement is a concept developed to measure quality in primary health care. The comparative analysis of patient enablement in an international context is lacking. Objective To explain variation in patient enablement between patients, general practitioners (GPs) and countries. To find independent variables associated with enablement. Design We constructed multi‐level logistic regression models encompassing variables from patient, GP and country levels. The proportions of explained variances at each level and odds ratios for independent variables were calculated. Setting and Participants A total of 7210 GPs and 58 930 patients in 31 countries were recruited through the Quality and Costs of Primary Care in Europe (QUALICOPC) study framework. In addition, data from the Primary Health Care Activity Monitor for Europe (PHAMEU) study and Hofstede's national cultural dimensions were combined with QUALICOPC data. Results In the final model, 50.6% of the country variance and 18.4% of the practice variance could be explained. Cultural dimensions explained a major part of the variation between countries. Several patient‐level and only a few practice‐level variables showed statistically significant associations with patient enablement. Structural elements of the relevant health‐care system showed no associations. From the 20 study hypotheses, eight were supported and four were partly supported. Discussion and Conclusions There are large differences in patient enablement between GPs and countries. Patient characteristics and patients’ perceptions of consultation seem to have the strongest associations with patient enablement. When comparing patient‐reported measures as an indicator of health‐care system performance, researchers should be aware of the influence of cultural elements.

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“…Because of the hierarchical structure of the data (with YPCC nested within projects), we conducted multilevel regression analysis with the outcome scale as a continuous variable (Leyland & Groenewegen, 2020). Several models were fitted to explain the variation in project outcomes.…”

Section: Methodsmentioning

confidence: 99%

Exploring the impact of patient and public involvement with young people with a chronic condition: A multilevel analysis

Schelven

Groenewegen

Spreeuwenberg

et al. 2021

Child

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Background Patient and Public Involvement (PPI) of young people with a chronic condition (YPCC) receives increasing attention. However, evidence of its impact is lacking. This study explores the impact of PPI on outcomes of projects in health and social care, using quantitative measures. Methods Data were collected from projects funded by a 4‐year participatory program addressing the social position of YPCC. These projects addressed challenges associated with, for example, going to college with a physical disability, transitions in care and finding a job. Project coordinators filled out project reports with questions about PPI, that is, to what extent were YPCC involved, were they involved as co‐deciders and were they involved in developing the project idea. YPCC filled out questionnaires with questions about PPI, that is, the number of PPI activities and self‐perceived importance for the project. They also answered questions about the influence of the project on their social position. Based on these questions, a project outcome scale was developed. Results The data concerned 17 projects and 146 YPCC. Variation existed in project outcomes, of which 27% was associated with differences between projects. Using multilevel analyses, a significant relation was found between the self‐perceived importance of YPCC for the project and the project outcomes they experience (0.232, p < 0.01). There was no significant association with the other PPI variables. Conclusions This study provided some first quantitative evidence that PPI has a positive impact on the YPCC involved. It is suggested that the meaningfulness of PPI matters more to them than the number of activities and amount of influence provided to YPCC. We strongly recommend conducting more research that critically examines impact of PPI.

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Multilevel Modelling for Public Health and Health Services Research

Cited by 99 publications

References 77 publications

Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries

Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries

Patient enablement after a consultation with a general practitioner—Explaining variation between countries, practices and patients

Exploring the impact of patient and public involvement with young people with a chronic condition: A multilevel analysis

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