Chu Yeong-Ruey, Chiang Liang-Yu, Kung Pei-Tseng, Tsai Wen-Chen
Department of Health Services Administration, China Medical University, No.100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan.
Department of Public Health, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan.
Int J Qual Health Care. 2025 Jul 4;37(3). doi: 10.1093/intqhc/mzaf075.
Most patients with chronic kidney disease (CKD) benefit from early intervention programs designed to slow disease progression and reduce medical usage. The Early-CKD Pay-for-Performance (Early-CKD P4P) program, implemented by Taiwan's National Health Insurance Administration since 2011, has proven effective in this regard. However, there is limited research on outcomes for patients who interrupt their participation in the program. The study aimed to compare risks of emergency department visits, hospitalizations, and dialysis between those who continued versus those who interrupted the Early-CKD P4P program.
The study was a retrospective cohort study using nationwide data from Taiwan's National Health Insurance Research Database. We examined patients aged 18 and older who joined the Early-CKD P4P program between 2014 and 2016, with follow-up until the end of 2021. Propensity score matching ensured comparability between groups. Log-linear Poisson regression assessed emergency department visits and hospitalizations, while Cox proportional hazard models evaluated dialysis risk.
A total of 100 228 participants joined the Early-CKD P4P program, with 37 457 in the continuous group and 62 771 in the interruption group, and 71 678 patients were matched. The patients who interrupted the program had significantly higher risks: emergency department visits were 3.41 times higher, hospitalizations 3.29 times higher, and the risk of dialysis was 5.46 times higher compared to the continuous group.
Premature interruption of the Early-CKD P4P program is associated with significantly increased risks of adverse outcomes. Sustained engagement in the program is crucial to reduce disease progression and healthcare utilization. These findings highlight the critical importance of ongoing participation in the Early-CKD P4P program to reduce adverse health outcomes. For the high rate of interruption observed in the study, future policies should focus on developing and implementing effective strategies to improve patient retention and maximize the benefits of this public health program.
大多数慢性肾脏病（CKD）患者受益于旨在减缓疾病进展和减少医疗使用的早期干预项目。台湾地区“国民健康保险局”自2011年起实施的早期慢性肾脏病按绩效付费（Early-CKD P4P）项目在这方面已被证明是有效的。然而，对于中断参与该项目的患者的结局研究有限。本研究旨在比较继续参与与中断Early-CKD P4P项目的患者之间急诊就诊、住院和透析的风险。
本研究是一项回顾性队列研究，使用了台湾地区“国民健康保险研究数据库”的全国性数据。我们考察了2014年至2016年间加入Early-CKD P4P项目、随访至2021年底的18岁及以上患者。倾向得分匹配确保了组间的可比性。对数线性泊松回归评估急诊就诊和住院情况，而Cox比例风险模型评估透析风险。
共有100228名参与者加入了Early-CKD P4P项目，其中持续参与组有37457人，中断组有62771人，71678名患者进行了匹配。中断项目的患者风险显著更高：与持续参与组相比，急诊就诊风险高3.41倍，住院风险高3.29倍，透析风险高5.46倍。
过早中断Early-CKD P4P项目与不良结局风险显著增加相关。持续参与该项目对于减缓疾病进展和医疗保健利用至关重要。这些发现凸显了持续参与Early-CKD P4P项目以减少不良健康结局的关键重要性。鉴于本研究中观察到的高中断率，未来政策应侧重于制定和实施有效的策略，以提高患者留存率并最大化该公共卫生项目的效益。
