191008 Influence of Breast Cancer Pay for Performance Initiatives on breast cancer survival and performance measures: A pilot study in Taiwan

Wednesday, October 29, 2008: 11:20 AM

Raymond Nien-Chen Kuo, PhD Candidate , Taiwan Cancer Registry, College of Public Health, National Taiwan University, Taiwan, Taipei City, Taiwan
Mei-Shu Lai, PhD , Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
Kuo-Piao Chung, PhD , Graduate Institute of Health Care Organization Administration, College of Public Health, National Taiwan University, Taiwan, Taipei City, Taiwan
     
Background

A national-wide Breast Cancer Pay for Performance (P4P) Initiatives was launched on November 2001, by the Bureau of National Health Insurance, to provide financial incentive to encourage guidelines-directed therapy and reward better patient survival. The purpose of this study is to investigate the difference of care performance between P4P Initiatives enrollees and none enrollees, and to figure out if such difference could reflect in better survival.

Methods

A cohort with 4,250 incident cases diagnosed in 2002 and 2003, identified from a population based cancer registry, was followed to the end of 2007. The National Health Insurance database is combined with cancer registry data to calculate the composite scores of performance measures, which is based on two pre-treatment and nine treatment Core Measure indicators.

Results

The mean of performance measures composite scores among P4P Initiatives enrollees is higher than none enrollees (p<0.001). The result of Cox regression analysis shows after controlled for age, cancer staging, and hospital service volume, patient in high composite score group is significantly associated with improved survival (HR 0.63, CI 0.48 - 0.83). P4P Initiatives enrollment also significantly associated with improved survival (HR 0.74, CI 0.60 - 0.92).Another analysis for only P4P enrolled hospitals (n= 1,257) shows that P4P Initiatives enrollment is also significantly associated with improved survival (HR 0.65, CI 0.47 - 0.90) under this sub-sample.

Discussion

This study shows that the Breast Cancer P4P Initiatives has some positive influence on performance of cancer care as well as survival. Future researches are needed to monitor its long-term effect.

Learning Objectives:
1.Evaluating the effect of breast cancer specific pay for performance program on patient survival 2. Compare the performance of care between P4P enrollees and none enrollees, with using a expert-panel reviewed Core Measure indicator set.

Keywords: Cancer, Performance Measures

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I'm one of the project team member and was authorized by the PI and Co-PI (listed as 2nd and 3rd authors) to present on the APHA annual meeting
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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