A nationwide cohort investigation on pay-for-performance and major adverse limb events in patients with diabetes

PREVENTIVE MEDICINE

卷:153

Article

Lu, Cheng-Wei¹  Wu, Yi-Fang²  Chen, Tien-Hsing³  Chung, Chang-Min⁴  Lin, Chun-Liang⁵  Lin, Yu-Sheng⁴  Chen, Mei-Yen^6,9  Yang, Yao-Hsu^7,10,11  Lin, Ming-Shyan^4,8 

[1] Chang Gung Mem Hosp, Dept Family Med, Chiayi, Taiwan

[2] Chang Gung Mem Hosp, Dept Emergency Med, Chiayi, Taiwan

[3] Chang Gung Mem Hosp, Dept Cardiol, Keelung, Taiwan

[4] Chang Gung Mem Hosp, Dept Cardiol, Chiayi, Taiwan

[5] Chang Gung Mem Hosp, Dept Nephrol, Chiayi, Taiwan

[6] Chang Gung Univ Sci & Technol, Dept Nursing, Chiayi, Taiwan

[7] Chang Gung Mem Hosp, Dept Tradit Chinese Med, Chiayi, Taiwan

[8] Chang Gung Univ, Grad Inst Clin Med Sci, Coll Med, Taoyuan, Taiwan

[9] Chang Gung Univ, Dept Nursing, Taoyuan, Taiwan

[10] Chang Gung Mem Hosp, Hlth Informat & Epidemiol Lab, Chiayi, Taiwan

[11] Chang Gung Univ, Sch Tradit Chinese Med, Coll Med, Taoyuan, Taiwan

关键词: Pay for performance (P4P);    Peripheral artery disease (PAD);    Amputation;    Major adverse limb events (MALE);    Mortality;    Financial incentives;   

DOI  :  10.1016/j.ypmed.2021.106787

来源: Elsevier

【 摘 要 】

A retrospective cohort study was conducted using claims data from Taiwan's National Health Insurance program to assess the effect of diabetic pay-for-performance (P4P) program on major adverse limb events (MALE) and major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). This study included patients with T2DM who had completed or not completed a 1-year P4P program from 2002 to 2013. Propensity-score matching was used to balance the baseline characteristics between groups. The Cox proportional-hazard model and Fine and Gray subdistribution hazard model were used to examine the association between P4P and the risks of MALE, MACE, systemic thromboembolism (ST), heart failure (HF) hospitalization, and all-cause mortality. Patients who underwent the P4P program had a significantly decreased incidence of MALE (2.0% vs. 2.6%, subdistribution hazard ratio [SHR] 0.73, 95% CI 0.71-0.76). Regarding the individual components, the P4P group demonstrated lower risks for foot ulcer (1.1% vs 1.3%, SHR 0.80, 95% CI 0.77-0.84), gangrene (0.57% vs 0.93%, SHR 0.59, 95% CI 0.56-0.63), percutaneous transluminal angioplasty (0.61% vs 0.79%, SHR 0.72, 95% CI 0.68-0.77), and amputation (0.46% vs 0.75%, SHR 0.58, 95% CI 0.55-0.62). In addition, the risks of MACE, ST, HF hospitalization, and all-cause mortality were remarkably lower in the P4P group. The P4P program might significantly reduce critical events of MALE, MACE, ST, HF, and mortality in the diabetic population.

【 授权许可】

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