Diabetes Shared Care Program (DSCP) and risk of infection mortality: a nationwide cohort study using administrative claims data in Taiwan

Abstract

ObjectiveThe Diabetes Shared Care Program (DSCP) is an integrated care model in Taiwan that has been proven to improve the care quality of patients with diabetes. We aimed to evaluate the efficacy of DSCP in decreasing the hospital mortality of infectious diseases.MethodsFrom 1 662 929 patients with type 2 diabetes newly diagnosed between 1999 and 2013, we retrieved a total of 919 patients who participated in the DSCP with the first hospitalisation for an infectious disease as the study cohort and 9190 propensity score-matched patients with type 2 diabetes who did not participate as the comparison.The efficacy of DSCP was evaluated via the following comparisons between the DSCP and non-DSCP cohorts: hospital mortality, 1-year medical cost prior to and during the hospitalisation, and complications, such as receiving mechanical ventilation and intensive care unit admission. The ratio (OR) for hospital mortality of the DSCP participants was calculated by logistical regression. Further stratification analyses were conducted to examine which group of patients with type 2 diabetes benefited the most from the DSCP during hospitalisation for infectious diseases.ResultsThe DSCP cohort had a lower hospital mortality rate than the non-DSCP participants (2.18% vs 4.82%, p<0.001). The total medical cost during the hospitalisation was lower in the DSCP cohort than in the non-DSCP cohort (NT$72 454±30 429 vs NT$86 385±29 350) (p=0.006). In the logistical regression model, the DSCP participants exhibited a significantly decreased adjusted OR for hospital mortality (adjusted OR=0.42, 95% CI 0.26 to 0.66, p=0.0002). The efficacy of the DSCP was much more prominent in male patients with type 2 diabetes and in patients with lower incomes.ConclusionParticipation in the DSCP was associated with a lower risk of hospital mortality for infectious diseases.

The effect of pay-for-performance program on infection events and mortality rate in diabetic patients: a nationwide population-based cohort study

“…Major mortality causes other than infections included diseases of the circulatory system, respiratory system, endocrine, nutritional, and metabolic diseases [5]. Less literature discussed infection death among T2DM patients [18,32]. In our study, the risk of infection-related death and all-cause mortality were both significantly lower in the P4P group than in the non-P4P group, which is consistent with previous investigations [16,18,32].…”

“…Less literature discussed infection death among T2DM patients [ 18 , 32 ]. In our study, the risk of infection-related death and all-cause mortality were both significantly lower in the P4P group than in the non-P4P group, which is consistent with previous investigations [ 16 , 18 , 32 ]. The P4P program was suggested to result in more frequent measures of HbA1C and set appropriate target of glycemic control [ 33 ].…”

“…Considering the improvement in diabetes care, we hypothesized that the P4P program will reduce infection-related complications and mortality rate in T2DM patients. Because previous research has smaller patient sample size and is limited on subgroup analysis of mortality and ER infections [ 18 , 19 ], we conducted the present population-based study to address the relationship between infection associated outcomes and the diabetes P4P program.…”

Effect of socioeconomic status on survival in patients on the Diabetes Shared Care Program: Finding from a Taiwan nationwide cohort

“…35 Chen et al demonstrated that participation in the DSCP programe was associated particularly with a lower risk of hospital mortality for infectious diseases than non-DSCP participants (2.18% vs 4.82%; p < 0.001). 36 Among the DSCP participants in our study, those with low individual SES had the highest risk of mortality, regardless of whether they lived in an advantaged or a disadvantaged neighborhood. Patients with low individual SES tended to live in rural and suburban areas or live in northern, central, and southern areas of Taiwan.…”

Effects of health-information-based diabetes shared care program participation on preventable hospitalizations in Taiwan

“…The examination of continued care and annual follow-ups will focus more on evaluation sections and based upon the baseline assessment (the details of items are provided in Additional file 1: Table S1) [7]. Hickman defined shared care as “the joint participation of hospital consultants and general practitioners in the planned delivery of care for patients with a chronic condition, informed by an enhanced information exchange over and above routine discharge and referral notes.” [8] Shared care also emphasizes multidisciplinary teamwork in diabetes management, including treating physicians, diabetes specialists, nurses, and dietitians [9]. Following the implementation of the DSCP, the standardized mortality rate in the diabetes population decreased from 39.8 in 2001 to 26.9 in 2011 [1].…”