Impact of pay-for-performance on mortality in diabetes patients in Taiwan: A population-based study.
Impact of pay-for-performance on mortality in diabetes patients in Taiwan: A population-based study.
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DOI：
10.1097/md.0000000000004197
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发表时间：
2016-07
期刊：
影响因子：
1.6
通讯作者：
Shi HY
中科院分区：
文献类型：
--
作者：
Chen YC;Lee CT;Lin BJ;Chang YY;Shi HY
按绩效付费（P4P）计划对慢性病（特别是糖尿病）长期死亡率的影响很少报道。几项研究描述了P4P对糖尿病医疗利用或中间结局的有利影响。因此，本研究旨在调查P4P计划对2型糖尿病患者死亡率的影响。在这项基于人群的队列研究中，P4P组为2090名初次诊断为2型糖尿病的患者，他们在2004年1月1日至2004年12月31日期间新入组台湾P4P项目。非P4P组患者按1：1比例匹配，通过倾向评分匹配（PSM）选择性别、年龄、诊断为糖尿病的第一年和其他32个潜在混杂因素。首次诊断糖尿病时的平均（SD）年龄为60.91（12.04）岁，基线时糖尿病的平均（SD）病程为4.3（1.9）年。采用时间依赖性考克斯回归模型探讨P4 P对全因死亡率的影响。在平均5.13年（SD = 1.07年）的随访期间，P4P组和非P4P组分别有206例和263例受试者死亡。校正基线时潜在混杂因素后，P4P组的生存期显著长于非P4P组（风险比，0.76 [95%置信区间，0.64-0.92]，P = 0.004，对数秩检验）。死亡率的降低相当于每37名在P4P项目中接受5.13年治疗的患者中减少一名死亡。在这项研究中，P4P计划显着增加了医生就诊和糖尿病相关检查的医疗利用，改善了前3年口服降糖药物的依从性和后3年胰岛素的依从性，并与癌症和慢性肾脏疾病的风险呈负相关。在年医疗费用方面，P4P组与非P4P组之间差异无统计学意义，P = 0.430。与对照组相比，按效付费方案在不增加医疗费用的情况下显著提高了糖尿病患者的生存率。P4P组患癌症和慢性肾脏疾病的风险显著降低。
Supplemental Digital Content is available in the text The impact of pay-for-performance (P4P) programs on long-term mortality for chronic illnesses, especially diabetes mellitus, has been rarely reported. Several studies described the favorable impact of P4P for diabetes mellitus on medical utilizations or intermediate outcomes. Therefore, this study aimed to investigate the impact of a P4P program on mortality in patients with type 2 diabetes. The P4P group in this population-based cohort study was 2090 individuals with a primary diagnosis of type 2 diabetes who had been newly enrolled in the P4P program of Taiwan between January 1, 2004 and December 31, 2004. Matched by 1:1 ratio, patients in the non-P4P group were selected by propensity score matching (PSM) for sex, age, the first year of diagnosis as diabetes, and 32 other potential confounding factors. Mean (SD) age was 60.91 (12.04) years when diabetes was first diagnosed and mean (SD) duration of diabetes was 4.3 (1.9) years at baseline. The time-dependent Cox regression model was used to explore the impact of P4P on all-cause mortality. During a mean of 5.13 years (SD = 1.07 years) of follow-up, 206 and 263 subjects died in the P4P group and the non-P4P group, respectively. After adjusting for the potential confounding factors at baseline, survival was significantly longer in the P4P group than in the non-P4P group (hazard ratio, 0.76 [95% confidence interval, 0.64–0.92], P = 0.004, by log-rank test). This decrease in mortality is equivalent to one less death for every 37 patients who were treated in the P4P program for 5.13 years. In this study, the P4P program significantly increased the medical utilization of physician visits and diabetes-related examinations, improved the adherence of oral hypoglycemic drugs during the first 3 years and that of insulin during the second 3 years, and was negatively associated with risk of cancer and chronic kidney disease. In annual health expense, there was no significant difference between P4P and non-P4P groups, P = 0.430. As compared with control, pay-for-performance program significantly improved survival in patients with diabetes without increasing the medical cost. The P4P group had significantly lower risk of cancer and chronic kidney disease.