Chen Tsung-Tai, Oldenburg Brian, Hsueh Ya-Seng
Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei 24205, Taiwan.
Noncommunicable Disease Control Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3053, Australia.
World J Diabetes. 2021 May 15;12(5):578-589. doi: 10.4239/wjd.v12.i5.578.
In this review, we discuss the chronic care model (CCM) in relation to the diabetes pay-for-performance (P4P) program in Taiwan. We first introduce the 6 components of the CCM and provide a detailed description of each of the activities in the P4P program implemented in Taiwan, mapping them onto the 6 components of the CCM. For each CCM component, the following three topics are described: the definition of the CCM component, the general activities implemented related to this component, and practical and empirical practices based on hospital or local government cases. We then conclude by describing the possible successful features of this P4P program and its challenges and future directions. We conclude that the successful characteristics of this P4P program in Taiwan include its focus on extrinsic and intrinsic incentives (, shared care network), physician-led P4P and the implementation of activities based on the CCM components. However, due to the low rate of P4P program coverage, approximately 50% of patients with diabetes cannot enjoy the benefits of CCM-related activities or receive necessary examinations. In addition, most of these CCM-related activities are not allotted an adequate amount of incentives, and these activities are mainly implemented in hospitals, which compared with primary care providers, are unable to execute these activities flexibly. All of these issues, as well as insufficient implementation of the e-CCM model, could hinder the advanced improvement of diabetes care in Taiwan.
在本综述中，我们讨论了台湾地区糖尿病绩效付费（P4P）项目中的慢性病照护模式（CCM）。我们首先介绍了CCM的6个组成部分，并详细描述了台湾实施的P4P项目中的各项活动，将它们对应到CCM的6个组成部分上。对于CCM的每个组成部分，我们描述了以下三个主题：CCM组成部分的定义、与此组成部分相关的一般实施活动，以及基于医院或地方政府案例的实践和实证做法。然后，我们通过描述该P4P项目可能的成功特点、面临的挑战及未来方向来得出结论。我们得出结论，台湾地区该P4P项目的成功特点包括其对外部和内部激励措施（共享照护网络）的关注、以医生为主导的P4P以及基于CCM组成部分开展的活动。然而，由于P4P项目的覆盖率较低，约50%的糖尿病患者无法享受与CCM相关活动的益处或接受必要的检查。此外，这些与CCM相关的活动大多没有得到足够的激励资金，且这些活动主要在医院实施，与基层医疗服务提供者相比，医院无法灵活开展这些活动。所有这些问题，以及电子CCM模式实施不足，都可能阻碍台湾地区糖尿病照护水平的进一步提升。
