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Observational Study
. 2018 Jul 12;8(7):e021382.
doi: 10.1136/bmjopen-2017-021382.

Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan

Cheng-Han Chen  1   2 , Sheng-Hsiang Ma  2   3 , Sung-Yuan Hu  4   5 , Chia-Ming Chang  1   2   6 , Jen-Huai Chiang  7 , Vivian Chia-Rong Hsieh  8 , David Hung-Tsang Yen  1   2 , Chorng-Kuang How #  1   2 , Ming-Shun Hsieh #  1   2   6   9
Affiliations
Observational Study

Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan

Cheng-Han Chen et al. BMJ Open. .

Abstract

Objective: The Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases.

Methods: From 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases.

Results: The DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes.

Conclusion: Participation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.

Keywords: Diabetes Shared Care Program (DSCP); diabetes and endocrinology; infection.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Participant selection process. DM, diabetes mellitus; DSCP, Diabetes Shared Care Program.
Figure 2
Figure 2
Cost and mortality rate in patients with diabetes with and without DSCP participation. DSCP, Diabetes Shared Care Program; OPD, outpatient department.
Figure 3
Figure 3
Stratification analysis of Diabetes Shared Care Program (DSCP) efficacy in infectious conditions with hospitalisation.
See this image and copyright information in PMC

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