Yen Fu-Shun, Cheng-Chung Wei James, Hung Yu-Tung, Hsu Chih-Cheng, Hwu Chii-Min
Dr. Yen's Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan.
Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo, N. Rd., South District, Taichung City 40201, Taiwan; Department of Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo, N. Rd., South District, Taichung City 40201, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih, Road, Taichung 40402, Taiwan.
Diabetes Res Clin Pract. 2022 Nov;193:110136. doi: 10.1016/j.diabres.2022.110136. Epub 2022 Oct 28.
To investigate the long-term outcomes of Pay-for-Performance (P4P) care in patients with young-onset (20-40 years of age) diabetes (YOD).
We recruited 3088 pairs of propensity-score matched patients with and without P4P care from the National Health Insurance Research Database between January 1, 2001, and December 31, 2017. The study used a multivariable Cox regression model to compare the risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes in YOD patients with and without P4P care.
The multivariable-adjusted model showed that patients with P4P care had significantly lower risks of mortality (aHR 0.31, 95% CI 0.25-0.38) and hospitalization for cardiovascular events (aHR 0.63, 95% CI 0.5-0.79) but a significantly higher risk of major microvascular outcomes (aHR 1.31, 95% CI 1.07-1.6). Patients with a longer cumulative duration of P4P and complete P4P care showed further lower risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes than those without P4P care.
This nationwide cohort study showed that young-onset diabetes patients with P4P care had lower risks of death and cardiovascular events but a higher risk of major microvascular outcomes. However, patients with a longer duration of P4P care showed lower risks of these outcomes.
探讨绩效付费（P4P）护理对青年发病（20 - 40岁）糖尿病（YOD）患者的长期结局。
我们从2001年1月1日至2017年12月31日的国民健康保险研究数据库中招募了3088对倾向评分匹配的接受和未接受P4P护理的患者。该研究使用多变量Cox回归模型比较接受和未接受P4P护理的YOD患者的死亡风险、心血管事件住院风险和主要微血管结局风险。
多变量调整模型显示，接受P4P护理的患者死亡风险（校正风险比[aHR] 0.31，95%置信区间[CI] 0.25 - 0.38）和心血管事件住院风险（aHR 0.63，95% CI 0.5 - 0.79）显著降低，但主要微血管结局风险显著升高（aHR 1.31，95% CI 1.07 - 1.6）。P4P累计持续时间较长且接受完整P4P护理的患者，其死亡、心血管事件住院和主要微血管结局风险比未接受P4P护理的患者更低。
这项全国性队列研究表明，接受P4P护理的青年发病糖尿病患者死亡和心血管事件风险较低，但主要微血管结局风险较高。然而，接受P4P护理时间较长的患者这些结局风险较低。
