按绩效付费计划是否能减少2型糖尿病患者因低血糖而前往急诊科就诊的次数？

Does the pay-for-performance programme reduce the emergency department visits for hypoglycaemia in type 2 diabetic patients?

作者信息

Yu Hung-Cheng, Tsai Wen-Chen, Kung Pei-Tseng

机构信息

Department of Healthcare Administration, Asia University, No. 500, Liufeng Rd., Wufeng District, Taichung City 41354, Taiwan, R.O.C., Department of Emergency, Tungs' Taichung Metro Harbor Hospital, No.699, Sec.1, Chungchi Rd., Wuchi District, Taichung City 43503, Taiwan, R.O.C. and Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, R.O.C. Department of Healthcare Administration, Asia University, No. 500, Liufeng Rd., Wufeng District, Taichung City 41354, Taiwan, R.O.C., Department of Emergency, Tungs' Taichung Metro Harbor Hospital, No.699, Sec.1, Chungchi Rd., Wuchi District, Taichung City 43503, Taiwan, R.O.C. and Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, Taichung 40402, Taiwan, R.O.C.

出版信息

Health Policy Plan. 2014 Sep;29(6):732-41. doi: 10.1093/heapol/czt056. Epub 2013 Jul 26.

DOI:10.1093/heapol/czt056

PMID:23894069

Abstract

OBJECTIVE

The pay-for-performance (P4P) programme for diabetes care was implemented in Taiwan to promote holistic care for diabetic patients. This study investigated the effect of P4P on the need for emergency care for diabetic hypoglycaemia.

RESEARCH DESIGN AND METHODS

The Taiwan National Health Insurance Research Database was used to gather nationwide data on patients with new-onset type 2 diabetes in 2001-09. Using the propensity score matching method, diabetes patients in the P4P programme and those not in P4P were matched, resulting in 199 626 people in each group. A Cox proportional hazards model was applied to analyse the risk of requiring emergency care for diabetic hypoglycaemia in P4P patients.

RESULTS

A total of 5519 patients sought emergency care for diabetic hypoglycaemia. Of them, 2097 (1.97%) were enrolled in regular P4P treatment, 1671 (1.79%) were enrolled in P4P and irregular treatment, whereas 1751 (0.88%) were not. The Cox proportional hazards model revealed that the risk of seeking emergency care for diabetic hypoglycaemia was higher in P4P patients, with an hazard ratio of 1.90 (95% CI: 1.73-2.08) for regular treatment and 1.32 (95% CI: 1.20-1.45) for irregular treatment. Others with a higher risk of diabetic hypoglycaemia included those older than 25 years, those with lower salaries, those living in less urban areas, those with catastrophic illness and those with a higher comorbidity or higher diabetes complication. Those treated in a non-public hospital were at a higher risk of diabetic hypoglycaemia than those in a public hospital. Patients treated in the higher service volume hospital were at a higher risk as well. Emergency visits due to diabetic hypoglycaemia after P4P were significantly higher than those before P4P.

CONCLUSION

When treating P4P patients, special care should be taken to help them avoid diabetic hypoglycaemia severe enough to require emergency care.

摘要

目的

台湾实施了糖尿病照护的绩效付费（P4P）计划，以促进对糖尿病患者的整体照护。本研究调查了P4P对糖尿病低血糖症急诊需求的影响。

研究设计与方法

使用台湾全民健康保险研究数据库收集2001 - 2009年全国新诊断2型糖尿病患者的数据。采用倾向得分匹配法，对参与P4P计划的糖尿病患者和未参与P4P计划的患者进行匹配，每组各有199626人。应用Cox比例风险模型分析P4P患者发生糖尿病低血糖症需急诊治疗的风险。

结果

共有5519例患者因糖尿病低血糖症寻求急诊治疗。其中，2097例（1.97%）接受常规P4P治疗，1671例（1.79%）接受P4P但治疗不规律，而1751例（0.88%）未接受P4P治疗。Cox比例风险模型显示，P4P患者因糖尿病低血糖症寻求急诊治疗的风险更高，常规治疗的风险比为1.90（95%置信区间：1.73 - 2.08），不规律治疗的风险比为1.32（95%置信区间：1.20 - 1.45）。其他糖尿病低血糖症风险较高的人群包括年龄超过25岁者、薪资较低者、居住在城市化程度较低地区者、患有重大疾病者以及合并症较多或糖尿病并发症较严重者。在非公立医院接受治疗的患者发生糖尿病低血糖症的风险高于公立医院的患者。在服务量较大医院接受治疗的患者风险也更高。P4P实施后因糖尿病低血糖症导致的急诊就诊显著高于P4P实施前。