Does the Diabetes Pay-for-Performance Program Reduce the Risk of Chronic Kidney Disease?

The purpose of this study was to explore the effect of the diabetes pay-for-performance (P4P) program on the quality of care and the risk for Chronic Kidney Disease (CKD). This study adopted the prospective design using claim data collected from a random sample of 1 MM beneficiaries of the National Health Insurance. We followed diabetes patients from their enrollment in the P4P program until the appearance of CKD or the end of the observation period in this study. A propensity score was applied to adjust for potential selection bias of being enrolled in the P4P program. In addition, four types of literature recommended examinations for diabetes patients: HbA1c, LDL, eye, and microalbuminuria, were grouped as high or low quality of care according to the frequencies received in the follow-up time. The Cox proportional hazard modeling was applied to explore the association between P4P enrollment and received quality of care and the risk of CKD. A total of 53 305 patients diagnosed with type-2 diabetes mellitus were indentified from the claim data, and 3494 cases were enrolled in the P4P program. After using the propensity score matching approach, 5088 patients were included in this study, of which 2544 enrolled in the P4P program. Of the 5088 patients, 50.14% were male, mean age was 62.52 years, 25% of the cases had at least on comorbidity, the mean of the Diabetes Complication Severity Index (DCSI)was 1.07. The mean follow-up period was 3.45 years, and a total of 1000 patients (19.65%) had CKD at the end of the follow-up. The patients were divided into four groups based on P4P enrollment and quality of care received: the cases enrolled in the P4P program and receiving high quality of care (N=1204), the cases enrolled in the P4P program but receiving low quality of care (N=1340), the non-P4P cases receiving high quality of care (N=27), and the non-P4P cases receiving low quality of care (N=2517). After controlling for the characteristics of the healthcare providers (ownership, region, and accreditation level) as well as the characteristics of the patients (sex, age, income, comorbidity, DCSI), the P4P group that received high quality of care had a significantly lower risk of CKD than the control group with non-P4P cases with low quality of care. (Hazard Ratios: 0.81; 95% CI: 0.69 to 0.95). We concluded that the P4P program combined with high quality of care could decrease the risk of CKD.