Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Science, Tunghai University, Taichung, Taiwan.
Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.
J Formos Med Assoc. 2019 Nov;118 Suppl 2:S122-S129. doi: 10.1016/j.jfma.2019.08.011. Epub 2019 Aug 27.
BACKGROUND/PURPOSE: Comprehensive and continuous care is crucial for patients with diabetes. The diabetes pay-for-performance (P4P) program launched by the National Health Insurance (NHI) administration in Taiwan provides a financial incentive to facilitate this goal. In this study, we explored the characteristics of patients in the P4P program between 2005 and 2014.
Data of patients with diabetes enrolled in the NHI program between 2005 and 2014 were extracted from the NHI research database. Patients were classed as having diabetes if they had three or more outpatient visits within 365 calendar days with an International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code of 250 or hospitalization one or more times with such a diagnosis. The trends of participating in the P4P program were analyzed.
Participation rate of the P4P program increased from 12.1% to 19% between 2005 and 2014. Participants were younger and more likely to be female than those not participating in the program. Lower risks of cancer-related mortality, annual mortality and heart failure were seen in patients participating in the P4P program than in those not participating.
Older, male patients with a high disease severity may be less likely to enroll in the P4P program. Although participation rate is increasing, a broad enrollment is expected.
背景/目的：全面持续的护理对糖尿病患者至关重要。台湾全民健康保险署推出的糖尿病按绩效付费（P4P）计划为实现这一目标提供了经济激励。本研究旨在探讨 2005 年至 2014 年 P4P 计划中患者的特征。
从全民健康保险研究数据库中提取 2005 年至 2014 年参加全民健康保险计划的糖尿病患者数据。如果患者在 365 个日历日内有 3 次或以上门诊就诊，且国际疾病分类第 9 版临床修订版诊断代码为 250，或有 1 次或以上住院诊断为该疾病，则将其归类为糖尿病患者。分析参加 P4P 计划的趋势。
2005 年至 2014 年，参加 P4P 计划的比例从 12.1%增加到 19%。与未参加计划的患者相比，参加者年龄较小，女性比例较高。参加 P4P 计划的患者癌症相关死亡率、年死亡率和心力衰竭的风险低于未参加者。
年龄较大、病情较重的男性患者可能不太愿意参加 P4P 计划。尽管参与率在增加，但预计参与人数会增加。
