The impact of pay-for-performance programs on hospitalization risks in subjects with type 1 diabetes mellitus: A nationwide cohort study

IF 2.3 4区医学 Q3 ENDOCRINOLOGY & METABOLISM

Primary Care Diabetes Pub Date : 2026-02-01 Epub Date: 2025-11-28 DOI:10.1016/j.pcd.2025.11.011

Yun-Kai Yeh , Fu-Shun Yen , James Cheng-Chung Wei , Yi-Ting Tsai , Heng-Jun Lin , Ying-Hsiu Shih , Chih-Cheng Hsu , Chii-Min Hwu

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引用次数: 0

Abstract

Aims

This retrospective cohort study aimed to investigate the impact of pay-for-performance programs (P4P) on hospitalization rates in individuals with type 1 diabetes mellitus (T1D).

Methods

Using propensity score matching, we recruited 625 pairs of individuals with T1D with and without P4P care from the National Health Insurance Research Database of Taiwan between January 1, 2006, and December 31, 2018. The study used a multivariable Cox regression model to compare the risks of hospitalization for various reasons in individuals with T1D with and without P4P care.

Results

Individuals with T1D receiving pay-for-performance (P4P) care demonstrated a significantly lower risk of all-cause hospitalization (adjusted hazard ratio [aHR] 0.63, 95 % confidence interval [CI] 0.54–0.73). This reduction was particularly notable for hospitalizations related to glucose management or metabolic disorders, infectious diseases, pneumonia, circulatory and respiratory system diseases, and mental health, compared with those not receiving P4P care. However, no significant differences were observed in hospitalization risks for hyperglycemic crisis, severe hypoglycemia, or injury between individuals with and without P4P care.

Conclusions

This nationwide cohort study found that P4P participation was associated with a lower risk of hospitalization in individuals with type 1 diabetes.

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绩效薪酬计划对1型糖尿病患者住院风险的影响：一项全国性队列研究

目的：本回顾性队列研究旨在探讨绩效薪酬计划（P4P）对1型糖尿病（T1D）患者住院率的影响。方法：采用倾向得分匹配方法，从2006年1月1日至2018年12月31日，从台湾全民健康保险研究数据库中招募625对有和没有P4P护理的T1D患者。本研究采用多变量Cox回归模型，比较接受和不接受P4P治疗的T1D患者因各种原因住院的风险。结果：接受按绩效付费（P4P）治疗的T1D患者的全因住院风险显著降低（校正风险比[aHR] 0.63, 95 %置信区间[CI] 0.54-0.73）。与未接受P4P治疗的患者相比，与葡萄糖管理或代谢紊乱、传染病、肺炎、循环和呼吸系统疾病以及精神健康相关的住院治疗中，这种减少尤为显著。然而，在接受和不接受P4P治疗的个体之间，高血糖危象、严重低血糖或损伤的住院风险没有显著差异。结论：这项全国性队列研究发现，参与P4P与1型糖尿病患者住院风险降低有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Primary Care Diabetes ENDOCRINOLOGY & METABOLISM-PRIMARY HEALTH CARE

CiteScore

5.00

自引率

3.40%

发文量

134

审稿时长

47 days

期刊介绍： The journal publishes original research articles and high quality reviews in the fields of clinical care, diabetes education, nutrition, health services, psychosocial research and epidemiology and other areas as far as is relevant for diabetology in a primary-care setting. The purpose of the journal is to encourage interdisciplinary research and discussion between all those who are involved in primary diabetes care on an international level. The Journal also publishes news and articles concerning the policies and activities of Primary Care Diabetes Europe and reflects the society''s aim of improving the care for people with diabetes mellitus within the primary-care setting.