Abstract
BackgroundDiabetes mellitus is a known risk factor for infection. Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients.MethodsThis is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabetic patients between 1 January 2002 and 31 December 2013 were included. Primary outcomes analyzed were patient emergency room (ER) infection events and deaths.ResultsAfter propensity score matching, there were 337,184 patients in both the P4P and non-P4P cohort. The results showed that patients’ completing one-year P4P program was associated with a decreased risk of any ER infection event (27.2% vs. 29%; subdistribution hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.86–0.88). While the number needed to treat was 58 for the non-P4P group, it dropped to 28 in the P4P group. The risk of infection-related death was significantly lower in the P4P group than in the non-P4P group (4.1% vs. 7.6%; HR 0.46, 95% CI 0.45–0.47). The effect of P4P on ER infection incidence and infection-related death was more apparent in the subgroups of patients who were female, had diabetes duration ≥5 years, chronic kidney disease, higher Charlson’s Comorbidity Index scores and infection-related hospitalization in the previous 3 years.ConclusionsThe P4P program might reduce risk of ER infection events and infection-related deaths in type 2 diabetic patients.
Highlights
Diabetes mellitus is a known risk factor for infection
The Pay for Performance (P4P) program was initiated in Taiwan for enhancing diabetes care since November 2001 [13], more than one quarter of diabetic patients are enrolled in the program annually [14]
Outcomes The results showed that completing the first year P4P program was associated with a decreased risk of any emergency room (ER) infection event (27.2% vs. 29%; subdistribution hazard ratio [Hazard ratio (HR)] 0.87, 95% confidence interval [Confidence interval (CI)] 0.86–0.88) (Fig. 2a)
Summary
Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients. There is a need for more medical interventions and more comprehensive diabetes care in order to diminish the risk of infection among T2DM patients [8]. Pay for Performance (P4P) program has been implemented in order to increase health care efficiency in many countries, including the United States, United Kingdom, Germany, and Taiwan [10]. Previous studies have showed that the P4P program, aimed at tackling diabetes, effectively increased clinical guideline adherence, quality of care, physician continuity, and decreased inpatient care utilization [13, 15,16,17]
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