National Taiwan University Hospital; and College of Public Health, National Taiwan University, Taipei City, Taiwan.
J Oncol Pract. 2011 May;7(3 Suppl):e8s-e15s. doi: 10.1200/JOP.2011.000314.
To evaluate the impact of the nationwide pay-for-performance (P4P) program for breast cancer care (BC-P4P) in Taiwan on care quality, patient survival, and recurrence.
A population-based observational study with cross-sectional design.
Retrospective analysis of population-based cancer registration and claims data was used in this study. A total of 4,528 patients with stage I or II breast cancer diagnosed in 2002 or 2003 who received curative surgery were observed until the end of 2008. This study applied multivariate linear regression to explore the association between BC-P4P enrollment and quality of care. Cox regression was applied to examine the effect of BC-P4P enrollment on 5-year recurrence and overall survival among patients with breast cancer.
After controlling for age, stage, type of surgery, and other factors, BC-P4P enrollees were found to have received better quality care than nonenrollees (P = .001). Cox regression models also indicated that after controlling for patient characteristics, quality of care was related to better 5-year overall survival (odds ratio [OR], 0.212; P = .001) and recurrence (OR, 0.289; P < .001). Even when controlled by quality of care provided to patients and its interaction with status of BC-P4P enrollment, BC-P4P enrollment remained statistically significant regarding 5-year overall survival (OR, 0.167; P < .001) and recurrence (OR, 0.370; P = .002).
Patients with breast cancer enrolled in the BC-P4P program received better quality care and had better outcome than nonenrolled patients. Evidence from this study indicates that financial incentives in the payment design had a positive impact on outcome of breast cancer care.
评估台湾全国乳腺癌保健按绩效付费（BC-P4P）计划对护理质量、患者生存和复发的影响。
这是一项基于人群的观察性研究，采用横断面设计。
本研究使用基于人群的癌症登记和索赔数据进行回顾性分析。共观察了 4528 名 2002 年或 2003 年诊断为 I 期或 II 期乳腺癌且接受根治性手术的患者，直至 2008 年底。本研究应用多元线性回归探讨 BC-P4P 参与与护理质量的关系。Cox 回归用于检验 BC-P4P 参与对乳腺癌患者 5 年复发和总生存的影响。
在控制年龄、分期、手术类型和其他因素后，发现 BC-P4P 参与者接受的护理质量优于非参与者（P =.001）。Cox 回归模型还表明，在控制患者特征后，护理质量与更好的 5 年总生存（比值比 [OR]，0.212；P =.001）和复发（OR，0.289；P <.001）相关。即使控制了患者接受的护理质量及其与 BC-P4P 参与状况的相互作用，BC-P4P 参与在 5 年总生存（OR，0.167；P <.001）和复发（OR，0.370；P =.002）方面仍然具有统计学意义。
参加 BC-P4P 计划的乳腺癌患者接受的护理质量更好，结局优于未参加的患者。本研究结果表明，支付设计中的财务激励对乳腺癌护理结局产生了积极影响。
