H-Y Lo1, S-L Yang1, H-H Lin2, K-J Bai3, J-J Lee4, T-I Lee5, C-Y Chiang6. 1. Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan. 2. Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan. 3. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, and Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. 4. Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan. 5. Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, and Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 6. Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Hsin-Long Road, Section 3, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France. cychiang@theunion.org.
Abstract
SETTING: The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. OBJECTIVE: To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. DESIGN: A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. RESULTS: The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients. CONCLUSIONS: Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.
SETTING: The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. OBJECTIVE: To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. DESIGN: A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabeticpatients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. RESULTS: The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4ppatients. CONCLUSIONS: Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.
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