The effects of a schizophrenia pay-for-performance program on patient outcomes in Taiwan
The effects of a schizophrenia pay-for-performance program on patient outcomes in Taiwan
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DOI：
10.1111/1475-6773.13174
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发表时间：
2019-10-01
影响因子：
3.4
通讯作者：
Wang, Vinchi
中科院分区：
文献类型：
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作者：
Chen, Tsung-Tai;Yang, Jing-Jung;Wang, Vinchi
目的探讨精神分裂症患者绩效付费（P4P）计划对健康结果的影响。数据来源对国家健康保险管理局（NHIA）数据库中7年（2007-2013）的数据进行了检查。研究设计P4P患者包括在参与机构接受治疗并连续纳入常规组（由NHIA分类）的患者。非P4P患者在非参与机构接受治疗，从未被纳入常规组。卡尺匹配方法和广义估计方程被用来估计差异中的差异模型（基线年2009年），并检查短期和长期的影响，P4P程序的不良后果。精神分裂症P4P项目与计划外门诊就诊（OR：0.69，P < 0.001）和强制入院（发病率比：0.33，P < 0.05）的减少相关。然而，该计划与其他结果的减少无关，包括任何疾病的急诊室就诊，急性精神病病房的入院以及6个月内的再入院。结论：虽然P4P项目的疾病管理部分可能有利于强制入院，但可以实施更复杂的活动，如针对弱势患者的健康促进，以减少复杂不良结局的发生。
Objective To examine the effects of a schizophrenia pay-for-performance (P4P) program on the health outcomes of patients in Taiwan. Data Sources Seven years (2007-2013) of data from the National Health Insurance Administration (NHIA) databases were examined. Study Design P4P patients included those who were treated at participating facilities and consecutively included in the regular group (classified by the NHIA). Non-P4P patients were treated at nonparticipating facilities and never included in the regular group. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the short- and long-term effects of the P4P program on adverse outcomes. Principal Findings The schizophrenia P4P program was associated with decreases in unscheduled outpatient visits (OR: 0.69, P < 0.001) and compulsory admissions (incidence rate ratio: 0.33, P < 0.05). However, this program was not associated with decreases in other outcomes including emergency department visits for any disease, admissions to an acute psychiatric ward, and readmission within 6 months. Conclusions Although the disease management component of the P4P program can be beneficial for compulsory admissions, more sophisticated activities, such as health promotion targeting disadvantaged patients, could be implemented to reduce the occurrence of complicated adverse outcomes.