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. 2021 Jan 21;21(1):78.
doi: 10.1186/s12913-021-06091-2.

The effect of pay-for-performance program on infection events and mortality rate in diabetic patients: a nationwide population-based cohort study

Yi-Fang Wu #  1 , Mei-Yen Chen #  2   3 , Tien-Hsing Chen  4   5   6 , Po-Chang Wang  7 , Yun-Shing Peng  8 , Ming-Shyan Lin  9   10   11
Affiliations

The effect of pay-for-performance program on infection events and mortality rate in diabetic patients: a nationwide population-based cohort study

Yi-Fang Wu et al. BMC Health Serv Res. .

Abstract

Background: Diabetes mellitus is a known risk factor for infection. Pay for Performance (P4P) program is designed to enhance the comprehensive patient care. The aim of this study is to evaluate the effect of the P4P program on infection incidence in type 2 diabetic patients.

Methods: This is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabetic patients between 1 January 2002 and 31 December 2013 were included. Primary outcomes analyzed were patient emergency room (ER) infection events and deaths.

Results: After propensity score matching, there were 337,184 patients in both the P4P and non-P4P cohort. The results showed that patients' completing one-year P4P program was associated with a decreased risk of any ER infection event (27.2% vs. 29%; subdistribution hazard ratio [HR] 0.87, 95% confidence interval [CI] 0.86-0.88). While the number needed to treat was 58 for the non-P4P group, it dropped to 28 in the P4P group. The risk of infection-related death was significantly lower in the P4P group than in the non-P4P group (4.1% vs. 7.6%; HR 0.46, 95% CI 0.45-0.47). The effect of P4P on ER infection incidence and infection-related death was more apparent in the subgroups of patients who were female, had diabetes duration ≥5 years, chronic kidney disease, higher Charlson's Comorbidity Index scores and infection-related hospitalization in the previous 3 years.

Conclusions: The P4P program might reduce risk of ER infection events and infection-related deaths in type 2 diabetic patients.

Keywords: Diabetes; Infection; Mortality; Pay-for-performance; Sepsis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection. T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; P4P, pay for performance
Fig. 2
Fig. 2
Cumulative incidence function under Fine and Gray method of any ER infection event (A) and cumulative event rates of infection death (B) of patients with or without one-year P4P program in the propensity score matched cohort
Fig. 3
Fig. 3
Pre-specified subgroup analysis of any ER infection event (A) and infection death (B)
See this image and copyright information in PMC

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