Kung Fang-Ping, Tsai Ching-Fang, Lu Chin-Li, Huang Li-Chung, Lu Chieh-Hsiang
Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital.
Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City.
Medicine (Baltimore). 2020 Feb;99(7):e19139. doi: 10.1097/MD.0000000000019139.
This study aimed to examine the effect of a diabetes pay-for-performance (P4P) program on all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Using a Taiwanese representative nationwide cohort, we recruited 5478 patients with newly diagnosed type 2 diabetes enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010 and individuals not enrolled in the P4P program were recruited as the control group matched 1:1 with the study group. We used multivariate Cox proportional hazard models analysis to investigate the effect of the P4P program and adherence on all-cause mortality. A total of 250 patients died in the P4P group compared to 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, P < .0001). The control group also had more comorbidities. Patients enrolled in the P4P program demonstrated significant long-term survival benefits, of which the adjusted hazard ratio (aHR) for all-cause mortality was 0.58 [95% CI (0.48-0.69)]. In the study group, better adherence to the P4P program resulted in a greater reduction in mortality, with aHRs [95% CI] of 0.48 [0.38-0.62] and 0.36 [0.26-0.49] in subjects with a minimum 1-year and 2-year good P4P adherence, respectively. Participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality, and this effect was particularly pronounced in the patients with better adherence to the P4P program.
本研究旨在探讨糖尿病按绩效付费（P4P）项目对新诊断2型糖尿病患者全因死亡率的影响。利用台湾具有代表性的全国性队列，我们招募了2002年1月1日至2010年12月31日期间确诊糖尿病后5年内参加P4P项目的5478例新诊断2型糖尿病患者，并招募未参加P4P项目的个体作为对照组，与研究组进行1:1匹配。我们使用多变量Cox比例风险模型分析来研究P4P项目和依从性对全因死亡率的影响。P4P组共有250例患者死亡，而对照组为395例（死亡率分别为每10000人年104例和169例，P<0.0001）。对照组的合并症也更多。参加P4P项目的患者显示出显著的长期生存获益，其中全因死亡率的调整后风险比（aHR）为0.58 [95%可信区间（CI）（0.48 - 0.69）]。在研究组中，对P4P项目的更好依从性导致死亡率更大幅度的降低，在至少有1年和2年良好P4P依从性的受试者中，aHRs [95% CI]分别为0.48 [0.38 - 0.62]和0.36 [0.26 - 0.49]。在糖尿病诊断后5年内参加P4P项目可显著降低全因死亡率，且这种效果在对P4P项目依从性更好的患者中尤为明显。
