Yi-Fang Wu1, Mei-Yen Chen2,3, Tien-Hsing Chen4,5,6, Po-Chang Wang7, Yun-Shing Peng8, Ming-Shyan Lin9,10,11. 1. Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 2. Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan. 3. Department of Nursing, Chang Gung University, Taoyuan, Taiwan. 4. Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan. 5. Biostatistical Consultation Center of Chang Gung Memorial Hospital, Keelung, Taiwan Community Medicine Research Center of Chang Gung Memorial Hospital, Keelung, Taiwan. 6. Chang Gung University, Taoyuan, Taiwan. 7. Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan. 8. Department of Endocrinology and Metabolism, Department of internal medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan. 9. Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan. mingshyan@gmail.com. 10. Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan. mingshyan@gmail.com. 11. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. mingshyan@gmail.com.
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.
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 diabeticpatients. METHODS: This is a retrospective longitudinal cohort study using data from the National Health Insurance Research Database in Taiwan. Diabeticpatients 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 diabeticpatients.
Authors: Lorien S Dalrymple; Yi Mu; Patrick S Romano; Danh V Nguyen; Glenn M Chertow; Cynthia Delgado; Barbara Grimes; George A Kaysen; Kirsten L Johansen Journal: Am J Kidney Dis Date: 2015-01-30 Impact factor: 8.860
Authors: Pieter Van Herck; Delphine De Smedt; Lieven Annemans; Roy Remmen; Meredith B Rosenthal; Walter Sermeus Journal: BMC Health Serv Res Date: 2010-08-23 Impact factor: 2.655