266097 Does the Diabetes Pay-for-Performance Program Reduce the Risk of Chronic Kidney Disease?

Tuesday, October 30, 2012

Pei-Ching Chen, PhD , Institute of Health and Welfare Policy, National Yan-Ming University, Taipei, Taiwan
Yue-Chune Lee, DrPH , Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
Raymond Kuo, PhD , Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
Yuh-Feng Lin, MD , Division of Nephrology, Department of Medicine, Shuang Ho Hospital, New Taipei, Taiwan
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.

Learning Areas:
Chronic disease management and prevention
Provision of health care to the public
Public health administration or related administration
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy
Public health or related research

Learning Objectives:
Explain the effect of the diabetes pay-for-performance program on the quality of care and the risk for Chronic Kidney Disease.

Keywords: Outcomes Research, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: It's part of my independent study. YC Lee(the second auther) is my advisors and I was authorised by the project director (YF Lin) to present at 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.