Impact of pay-for-performance on mortality in diabetes patients in Taiwan

Chen, Yu Ching; Lee, Charles Tzu Chi; Lin, Boniface J.; Chang, Yong Yuan; Shi, Hon Yi

doi:10.1097/md.0000000000004197

Cited by 37 publications

(45 citation statements)

References 35 publications

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“…The other outcomes identified that are not reported here were: mortality (2 articles), weight change (4 articles), depression (1 article), health-related quality of life (4 articles), device satisfaction (1 article), hypoglycemic events (9 articles), and assorted clinical outcomes (1 article). This focus on the three outcomes of glycemic control, healthcare resource use, and healthcare costs limited the final selection to 34 studies, which excludes analysis of four of the studies retrieved [ 39 – 42 ]. Table 1 summarizes selected study characteristics.…”

Section: Resultsmentioning

confidence: 99%

Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes

Hamersky

Fridman²,

Gamble

et al. 2019

Diabetes Ther

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Introduction Improving real-world medication adherence to injectable antihyperglycemics in type 2 diabetes mellitus (T2DM) is a clinical challenge. Quantification of the level of adherence required to achieve a minimal clinically important difference (MCID) in glycemic control would assist in meeting this goal. The study objective was to review the literature regarding the relationships of medication adherence and persistence with health outcomes in adult T2DM patients using injectable antihyperglycemics. Methods Systematic searches were conducted using electronic databases to identify publications over the last decade. Publications were screened against established eligibility criteria. Study data were extracted, evaluated, and used to identify strengths, limitations, and gaps in current evidence. Results Eligibility criteria were met by 38 studies, and this report analyzed 34 studies related to glycemic control ( n = 25), healthcare resource use ( n = 9), and healthcare costs ( n = 14). Eight of these studies examined adherence to glucagon-like peptide-1 receptor agonists (GLP-1 RA), including 1 study regarding adherence to GLP-1 RA or to insulin, and 1 study investigating a GLP-1 RA/insulin combination; the remaining studies involved insulin. Studies used a broad range of measures to classify adherence and persistence, and most measures were unable to reliably evaluate the complexities of patient behavior over time. Better adherence to injectable antihyperglycemic medications was generally found to be associated with improved glycemic control, although no studies attempted to identify a MCID. Although higher diabetes-related pharmacy and total healthcare costs were reported for adherent or persistent patients, these patients tended to have lower diabetes-related and all-cause medical costs. Conclusion Results of this review confirmed the effectiveness of injectable antihyperglycemic medications for glycemic control, suggesting that there are clinical and financial consequences to nonadherence. Although attempts were made to quantify the effects of nonadherence, the interpretation of study results was limited by the lack of a MCID and inadequate study design. Funding Novo Nordisk, Inc., Plainsboro Township, NJ, USA. Plain Language Summary Plain language summary available for this article. Electronic Supplementary Material The online version of this article (10.1007/s13300-019-0617-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes

Hamersky

Fridman²,

Gamble

et al. 2019

Diabetes Ther

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“…The P4P program provides comprehensive diabetes management, including regular surveillance of blood glucose, glycated hemoglobin (hemoglobin A 1C ), serum creatinine, urine albumin/creatinine ratio, and systolic and diastolic blood pressure. A specialized case manager is held accountable for ensuring that therapy is continual and each patient with DM is well educated regarding DM control.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with DM were included if they (1) had at least 1 hospital admission or at least 3 outpatient visits with a DM diagnostic code (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) within 365 calendar days; (2) received insulin or diabetes-specific hypoglycemic agents for ࣙ90 cumulative defined daily doses (DDDs) 13 within 365 days; and (3) were enrolled in the P4P program, defined as having at least 2 billing codes containing P14x (internal code) in admission or outpatient records within 365 calendar days. 14 The P4P program provides comprehensive diabetes management, 15 including regular surveillance of blood glucose, glycated hemoglobin (hemoglobin A 1C ), serum creatinine, urine albumin/creatinine ratio, and systolic and diastolic blood pressure. A specialized case manager is held accountable for ensuring that therapy is continual and each patient with DM is well educated regarding DM control.…”

Section: Cohort Selectionmentioning

confidence: 99%

Association of Metformin Use With End‐Stage Renal Disease in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study Under the Pay‐for‐Performance Program

Lee

Chang

et al. 2019

The Journal of Clinical Pharma

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Animal studies have demonstrated that metformin exerts a renoprotective effect. Human studies of patients with diabetes mellitus (DM) regarding the association of metformin use with end‐stage renal disease (ESRD) are lacking. Patients with type 2 DM and without a history of kidney disease who were enrolled under the pay‐for‐performance program of the National Health Insurance in Taiwan were identified. Those who received ≥90 cumulative defined daily doses of metformin within 1 year were selected (metformin users) and compared with a 1:1 propensity score–matched metformin nonuser cohort. Primary and secondary outcomes were development of ESRD and chronic kidney disease (CKD), respectively. Independent predictors were investigated using Cox regression analysis. A total of 24 158 pairs of metformin users and nonusers were enrolled, with an incidence of ESRD of 1908 and 1723 and CKD of 1095 and 1056 cases per 100 000 person‐years, respectively. Metformin use was independently associated with increased risks of ESRD (adjusted hazard ratio, 1.22; 95% confidence interval, 1.12‐1.32) and CKD (adjusted hazard ratio, 1.25; 95% confidence interval, 1.12‐1.40) in a dose‐response relationship. Patients with hypertension plus nonuse of angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers potentiated kidney damage by metformin. In patients with DM, use of metformin may increase the risk of ESRD and CKD. Health care professionals should be alert and closely monitor renal function when prescribing metformin.

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“…Most patients with PAD are asymptomatic, but they have elevated risk for mortality [22][23][24]. In Taiwan, annual screening for foot complications is recommended in the clinical guidelines and in the P4P program for patients with DM [13,25]. In previous studies that have used the cutoff value of ABI ≤ 0.90, the prevalence of PAD in type 2 DM was about 10.0% in patients with a mean age of 63 years in Taiwan, 10.4% in Malay patients (mean age, 63 years) who living in Singapore, and 9.5% in patients (age > 40 years) in the US [26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Use of the Combination of Ankle-brachial Index and Percentage of Mean Arterial Pressure at Ankle for Improving Prediction of All-cause Mortality in type 2 Diabetes Mellitus

Sheu

Lee

2020

Preprint

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Background: Peripheral artery disease (PAD) in lower extremities is a common complication in type 2 diabetes and has shown to be associated with mortality. The ankle-brachial index (ABI) is a simple noninvasive method to screen PAD, but has limited sensitivity. We hypothesized that using the percentage of mean arterial pressure (%MAP) and the ABI in combination would improve prediction of mortality.Methods: We retrospectively collected the data of patients with type 2 diabetes who had undergone measurement of ABI and %MAP at our hospital. We separated the cohort into four groups according to the ABI and %MAP values, and examined these indices were associated with mortality.Results: A total of 5101 patients (mean age, 65 ± 11 years) were enrolled. During the follow-up period (median, 22.9 months), 266 (4.8%) of enrolled patients died. The combination of ABI and %MAP was significantly better at predicting mortality than ABI alone. (C index: 0.62 [95% CI: 0.57, 0.65] vs. 0.57 [95% CI: 0.53, 0.62], P = 0.038). In multivariate analysis (with ABI >0.90 and %MAP ≤45% as the reference group), the highest risk of mortality was seen in patients with ABI ≤0.90 and %MAP >45% (hazard ratio = 1.983 [95% CI: 1.380, 2.848], P < 0.001).Conclusions: Adding %MAP to ABI appears to significantly improve the predictive ability for all-cause mortality in patients with type 2 diabetes.

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Impact of pay-for-performance on mortality in diabetes patients in Taiwan

Abstract: Supplemental Digital Content is available in the text

Cited by 37 publications

References 35 publications

Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes

Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes

Association of Metformin Use With End‐Stage Renal Disease in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study Under the Pay‐for‐Performance Program

Use of the Combination of Ankle-brachial Index and Percentage of Mean Arterial Pressure at Ankle for Improving Prediction of All-cause Mortality in type 2 Diabetes Mellitus

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