Long-Term and Interactive Effects of Pay-For-Performance Interventions among Diabetic Nephropathy Patients at the Early Chronic Kidney Disease Stage

Liao, Pei-Ju; Lin, Tzu-Yu; Wang, Tzu-Ching; Ting, Ming-Kuo; Wu, I‐Wen; Huang, Hsin-Tsung; Wang, Fu-Chung; Chang, Huan‐Cheng; Hsu, Kuang‐Hung

doi:10.1097/md.0000000000003282

Cited by 13 publications

(7 citation statements)

References 35 publications

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“…A meta-analysis of early versus late referrals to nephrologists indicated a significantly higher overall mortality, longer hospital stay, and early at the time of renal replacement therapy initiation in the late referrals compared with the early referrals 42 . It was previously reported in a study of 32,084 early CKD patients from the NHIRD in Taiwan that an early CKD P4P intervention resulted in a significantly better prognosis in all-cause mortality among matched participants in both P4P programs 43 . Furthermore, the analysis of advanced CKD cases in the present study confirmed that the P4P program for pre-ESRD care education is a crucial tool to improve survival and patient outcomes.…”

Section: Discussionmentioning

confidence: 94%

Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Chou

Chung

Chiu

et al. 2021

Sci Rep

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There is little comprehensive education for people with end-stage renal disease (ESRD) progress. We investigated the differences in terms of outcomes between patients with CKD stages 3–5 who enrolled and did not enroll in the pre-ESRD care education in Taiwan. This retrospective cohort study was conducted using data from the National Health Insurance Research Database (NHIRD). All patients diagnosed with CKD stages 3–5 who received the pre-ESRD care education through the pay for performance (P4P) program were enrolled. Based on whether or not they participated in the program, they were categorized into P4P or non-P4P groups. All analyses were performed from January 2006 through December 2015. Study outcomes were risk of hemodialysis dependency, hospitalization, and all-cause mortality. In this study of 29,337 patients, those with CKD stages 3–5 in the P4P group had lower events of hemodialysis, hospitalization, and all-cause mortality compared to patients in the non-P4P group. This study suggested that pre-ESRD care education is associated with increased patient outcomes, resulting in lower hemodialysis and hospitalization events and a higher overall survival rate in patients with CKD stages 3–5. Patient education could raise opportunities to improve pre-ESRD care by reaching patients outside the traditional health care setting.

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Section: Discussionmentioning

confidence: 94%

Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Chou

Chung

Chiu

et al. 2021

Sci Rep

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“…In other words, we need more evidence-based studies on the long term outcome of P4P programs to convince primary care physicians to participate in P4P programs for quality improvement in healthcare. Using diabetic care as an example, in Taiwan, most related studies show that diabetes P4P programs result in favorable outcome in process (examining HbA1C, LDL), patient outcome (decreasing mortality, nephropathy, and cost-effectiveness analyses) [28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

et al. 2020

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Background: The National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs. Methods: We conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-forperformance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not. Results: A total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78~4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.503 .83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31~0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%). Conclusions: To better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.

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“…Diabetes mellitus (DM) is now regarded as one of the most challenging public health problems worldwide 1 . Both the economic burden and loss of health caused by complications of DM indicate the importance of primary prevention and early intervention in the management of DM 2 , 3 . Diabetic retinopathy (DR) is a common microvascular complication of DM and a major preventable cause of visual impairment in the working-age population 4 .…”

Section: Introductionmentioning

confidence: 99%

Association of alcohol intake with risk of diabetic retinopathy: a meta-analysis of observational studies

Zhu

et al. 2017

Sci Rep

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Diabetic retinopathy (DR) is a common microvascular complication of diabetes mellitus (DM). The associations of alcohol intake with DR risk have demonstrated contradictory results. Relevant studieswere identified by searching electronic databases (Medline, EMBASE and Web of Science) until May 2016. We identified a total of 12,875 DR cases among 37,285 participants in 15 observational studies. The pooled estimation of all the included observational studies was 0.91 (95% CI, 0.79 to 1.06) in a random-effect model. Analyses stratified by study design showed no significant association between alcohol intake and DR incidence in cohort, case control or cross-sectional studies. In the subgroup analyses, neither beer nor spirits intake were associated with DR risk. Furthermore, it was interesting to find that protective effects were detected in the wine (OR = 0.77, 95% CI = 0.64 to 0.92) and sherry (OR = 0.22, 95% CI = 0.05 to 0.95) groups. In conclusion, this current meta-analysis demonstrated that alcohol intake was not associated with risk of DR. Subgroup analysis by alcoholic beverage types showed that wine consumption would reduce the incidence of DR. In the future, more large-scale prospective studies with detailed alcohol subtypes and contents are still warranted to clarify the association.Diabetes mellitus (DM) is now regarded as one of the most challenging public health problems worldwide 1 . Both the economic burden and loss of health caused by complications of DM indicate the importance of primary prevention and early intervention in the management of DM 2, 3 . Diabetic retinopathy (DR) is a common microvascular complication of DM and a major preventable cause of visual impairment in the working-age population 4 . Accordingly, early detection of DR in the DM population is crucial. The mechanisms of DR development and progression are still not fully understood 5,6 . Previous epidemiological studies indicated that longer DM duration, older age, aging and cardiovascular events were risk factors for DR incidence 7,8 .Alcohol intake is reported to be a risk factor for several kinds of diseases, including cancers, gastrointestinal diseases, respiratory disorders and infections [9][10][11] . A quantitative review of 26 epidemiological studies reported an inverse association between alcohol intake and risk of type 2 DM (T2DM) in a non-linear dose-response manner. It was found that light and moderate alcohol consumption was associated with a lower risk of T2DM, whereas heavy alcohol consumption demonstrated no protective effect against T2DM risk 12 . Furthermore, in an advanced study, specific types of alcoholic beverage consumption demonstrated modified influences on T2DM risk. In a meta-analysis of 13 prospective studies, compared with beer or spirits, wine was associated with a more significant inverse risk of DM 13 .In previous studies, the associations of alcohol intake with DR risk demonstrated contradictory results. Alcohol intake, which was regarded as an unhealthy lifestyle behavior, was previously regarded a...

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Long-Term and Interactive Effects of Pay-For-Performance Interventions among Diabetic Nephropathy Patients at the Early Chronic Kidney Disease Stage

Abstract: Supplemental Digital Content is available in the text

Cited by 13 publications

References 35 publications

Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Association of pre-ESRD care education with patient outcomes in a 10-year longitudinal study of patients with CKD stages 3–5 in Taiwan

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

Association of alcohol intake with risk of diabetic retinopathy: a meta-analysis of observational studies

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