Abstract
Inadequate care of chronic kidney disease (CKD) is common and may be associated with adverse outcomes after dialysis. The nationwide pre-end-stage renal disease pay for performance program (P4P) has been implemented in Taiwan to improve quality of CKD care. However, the effectiveness of the P4P program in improving the outcomes of pre-dialysis care and dialysis is uncertain. We conducted a longitudinal cohort study. Patients who newly underwent long-term dialysis (≥3 mo) between 2007 and 2009 were identified from the Taiwan National Health Insurance Research Database. Based on the patient enrolment of the P4P program, they were categorized into P4P or non-P4P groups. We analysed pre-dialysis care, healthcare expenditures, and mortality between two groups. Among the 26 588 patients, 25.5% participated in the P4P program. The P4P group received significantly better quality of care, including a higher frequency of glomerular filtration rate measurement and CKD complications survey, a higher rate of vascular access preparation, and more frequent use of arteriovenous fistulas than the non-P4P group did. The P4P group had a 68.4% reduction of the 4-year total healthcare expenditure (excluding dialysis fee), which is equivalent to US$345.7 million, and a significant 22% reduction in three-year mortality after dialysis (hazard ratio 0.78, 95% confidence interval: 0.75–0.82, P < 0.001) compared with the non-P4P group. P4P program improves quality of pre-dialysis CKD care, and provide survival benefit and a long-term cost saving for dialysis patients.
Highlights
IntroductionThe number of patients receiving renal replacement therapy is projected to steadily increase from 2.618 million in 2010 to 5.439 million in 2030 worldwide, mostly in developed countries[1]
Chronic kidney disease (CKD) is a crucial public health concern worldwide
This paper is the first study to evaluate the effect of a national pre-end-stage renal disease (ESRD) P4P program on patients who underwent dialysis
Summary
The number of patients receiving renal replacement therapy is projected to steadily increase from 2.618 million in 2010 to 5.439 million in 2030 worldwide, mostly in developed countries[1]. Pay-for-performance (P4P) is a promising approach to improving the quality of health care by linking financial incentives to provider’s performance. In Taiwan, a nationwide preESRD P4P care programme was launched to provide more comprehensive care to patients with advanced CKD in 2006. Under this incentive scheme, nephrologists are requested to provide care more closely following clinical guidelines, based on a multidisciplinary team [4]
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