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. 2018 Aug 15;18(1):638.
doi: 10.1186/s12913-018-3454-6.

Pay for performance program reduces treatment needed diabetic retinopathy - a nationwide matched cohort study in Taiwan

Shwu-Jiuan Sheu  1   2 , Wen-Liang Lin  3 , Yea-Huei Kao Yang  4 , Chi-Min Hwu  2   5 , Ching-Lan Cheng  6   7
Affiliations

Pay for performance program reduces treatment needed diabetic retinopathy - a nationwide matched cohort study in Taiwan

Shwu-Jiuan Sheu et al. BMC Health Serv Res. .

Abstract

Background: Pay-for-Performance programs have shown improvement in indicators monitoring adequacy and target achievement in diabetic care. However, less is known regarding the impact of this program on the occurrence and long-term effects of diabetic retinopathy. The objective of this study was to determine the effect of pay-for-performance program on the development of treatment needed for diabetic retinopathy in type 2 diabetes patients.

Methods: We conducted a nationwide retrospective cohort study with a matching design using the Taiwan National Health Insurance Research Database from 2000 to 2012. The outcome was defined as the treatment needed diabetic retinopathy. We matched Pay-for-Performance and non-Pay-for-Performance groups for age, gender, year diabetes was diagnosed and study enrollment, and duration of follow-up.

Results: A total of 9311 patients entered the study cohort, of whom 2157 were registered in the Pay-for-Performance group and 7154 matched in the non-Pay-for-Performance group. The incidence of treatment needed diabetic retinopathy was not significantly different in two groups. However, the incidence of treatment needed diabetic retinopathy was significantly different if restricted the non-Pay-for-Performance group who had at least 1 eye examination or optical coherence tomography within 1 year (adjusted hazard ratio, 0.78; 95% confidence interval, 0.64-0.94).

Conclusions: Pay-for-Performance is valuable in preventing the development of treatment needed diabetic retinopathy, which could be attributed to the routine eye examination required in the Pay-for-Performance program. We could improve our diabetic care by promoting eye health education and patient awareness on the importance of regular examinations.

Keywords: Detection bias; Diabetic retinopathy; NHIRD; Pay-for-performance.

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Conflict of interest statement

Ethics approval and consent to participate

The personal information of all patients is encrypted, researchers using the NHIRD are required to sign a written declaration and must not gather information that could violate patients’ or care providers’ privacy. Simultaneously, researchers must closely follow the Taiwan Personal Information Protection Act. The hospital Institutional Review Board and Ethics Committee approved this study, which adhered to the tenets of the Declaration of Helsinki; patient consent was not required (VGHKS14-CT3–04).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The algorithm of cohort assembly
Fig. 2
Fig. 2
The survival analysis of DR risk
See this image and copyright information in PMC

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