Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study

Chou, Chien-Wen; Kung, Pei‐Tseng; Chou, Wen-Yu; Tsai, Wen‐Chen

doi:10.1136/bmjopen-2018-026626

Cited by 12 publications

(13 citation statements)

References 32 publications

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“…Other possible explanations could include the influence of the nationwide quality improvement initiative on the quality of stroke care 16 and a newly implemented pay-for-performance program for AIS in Taiwan. Similar to the pay-for-performance program for diabetes care, 17,18 this program uses ICD codes in the primary diagnosis field to define AIS. These quality improvement activities may provide an incentive for hospitals to improve the accuracy of diagnostic coding for AIS because a high false-positive rate of diagnosis of AIS may create a bias for the measurement of hospital performance.…”

Section: Discussionmentioning

confidence: 99%

<p>Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database</p>

Hsieh¹,

Hsieh²,

Tsai³

et al. 2020

CLEP

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The validity of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding for the identification of acute ischemic stroke (AIS) in Taiwan's National Health Insurance claims database has not been investigated. This study aimed to construct and validate the case definition algorithms for AIS based on ICD-10-CM diagnostic codes. Patients and Methods: This study identified all hospitalizations with ICD-10-CM code of I63* in any position of the discharge diagnoses from the inpatient claims database and all patients with a final diagnosis of AIS from the stroke registry between Jan 2018 and Dec 2019. Hospitalizations in the claims data that could be successfully linked to those in the registry data were regarded as true episodes of AIS. Otherwise, their electronic medical records and images were manually reviewed to ascertain whether they were true episodes of AIS. Using the true episodes of AIS as the reference standard, the positive predictive value (PPV) and sensitivity of various case definition algorithms for AIS were calculated. Results: A total of 1227 hospitalizations were successfully linked. Among the 155 hospitalizations that could not be linked, 54 were determined to be true episodes of AIS. Using ICD-10-CM code of I63* in any position of the discharge diagnoses to identify AIS yielded a PPV and sensitivity of 92.7% and 99.4%, respectively. The PPV increased to 99.8% with >12% decrease in the sensitivity when AIS was restricted to those with I63* as the primary diagnosis. When AIS was defined to be I63* as the primary, first secondary, or second secondary diagnosis, both PPV and sensitivity were greater than 97%. Conclusion: This study demonstrated the validity of various case definition algorithms for AIS based on ICD-10-CM coding and can provide a reference for future claims-based stroke research.

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Section: Discussionmentioning

confidence: 99%

<p>Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database</p>

Hsieh¹,

Hsieh²,

Tsai³

et al. 2020

CLEP

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“…Of practical relevance, meticulous care offered to DM subjects is important. A large prospective study found that intensified healthcare vs. standard care reduced the risk of stroke [ 54 ]. This therapeutic challenge awaits confirmation and broader implementation.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

Penlioglou

Stoian

Παπάνας

2021

JCM

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Background: Stroke remains a leading cause of death and disability throughout the world. It is well established that Diabetes Mellitus (DM) is a risk factor for stroke, while other risk factors include dyslipidaemia and hypertension. Given that the global prevalence of diabetes steadily increases, the need for adequate glycaemic control and prevention of DM-related cardiovascular events remains a challenge for the medical community. Therefore, a re-examination of the latest data related to this issue is of particular importance. Objective: This review aims to summarise the latest data on the relationship between DM and stroke, including epidemiology, risk factors, pathogenesis, prevention and biomarkers. Methods: For this purpose, comprehensive research was performed on the platforms PubMed, Google Scholar and EMBASE with a combination of the following keywords: diabetes mellitus, stroke, macrovascular complications, diabetic stroke, cardiovascular disease. Conclusions: Much progress has been made in stroke in people with DM in terms of prevention and early diagnosis. In the field of prevention, the adaptation of the daily habits and the regulation of co-morbidity of individuals play a particularly important role. Simultaneously, the most significant revolution has been brought by the relatively new treatment options that offer protection to the cardiovascular system. Moreover, many prognostic and diagnostic biomarkers have been identified, paving the way for early and accurate diagnoses. However, to date, there are crucial points that remain controversial and need further clarification.

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“…Healthcare claim data for all included patients were reviewed to determine whether the P4P model had been used following the onset of T2DM. Patients were considered as P4P users if their claim files were noted with the code of "E4" in the treatment claims after diabetes onset (13), whereas the remaining subjects were classified as non-P4P users. In Taiwan, P4P has been applied to several chronic diseases, including diabetes (13,14) and schizophrenia (18,19).…”

Section: Study Populationmentioning

confidence: 99%

“…Patients were considered as P4P users if their claim files were noted with the code of "E4" in the treatment claims after diabetes onset (13), whereas the remaining subjects were classified as non-P4P users. In Taiwan, P4P has been applied to several chronic diseases, including diabetes (13,14) and schizophrenia (18,19). P4P has been launched into routine clinical practice since 2001, with the aim of providing holistic care to complex or high-resource patients, particularly those with T2DM (20).…”

Section: Study Populationmentioning

confidence: 99%

“…Moreover, in order for the patient to stabilize the disease and improve quality of life, it is necessary to actively participate in programs, and regularly follow-up with case management, allowing patients to receive regular visits and evaluate physician-prescribed medications to reduce the development of any complications (11). A growing body of scientific evidence indicates that implementing P4P significantly increases the quality and satisfaction of medical care for diabetic patients (12), and diminishes the burden of disease-generated complications (13,14). At present, no data are available on the success of P4P in decreasing the risk of depression among T2DM patients.…”

Section: Introductionmentioning

confidence: 99%

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Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan

Lian

Livneh

Huang

et al. 2021

Front. Public Health

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Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients.Methods: This cohort study used a nationwide health insurance database to identify patients 20–70 years of age newly diagnosed with T2DM who enrolled in the P4P program between 2001 and 2010. From this group, we enrolled 17,022 P4P users and then 17,022 non-P4P users who were randomly selected using propensity-score–matching. Enrolled patients were followed until the end of 2012 to record the occurrence of depression. The Cox proportional hazards regression was utilized to obtain the adjusted hazard ratio (aHR) for P4P use.Results: During the study period, a total of 588 P4P users and 1,075 non-P4P users developed depression at incidence rates of 5.89 and 8.41 per 1,000 person-years, respectively. P4P users had a lower depression risk than did non-P4P users (aHR, 0.73; 95% Confidence Interval, 0.65–0.80). This positive effect was particularly prominent in those receiving high-intensity use of the P4P program.Conclusion: Integrating P4P into routine care for patients with T2DM may have beneficial effects on curtailing the subsequent risk of depression.

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Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study

Cited by 12 publications

References 32 publications

<p>Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database</p>

<p>Performance of ICD-10-CM Diagnosis Codes for Identifying Acute Ischemic Stroke in a National Health Insurance Claims Database</p>

Diabetes, Vascular Aging and Stroke: Old Dogs, New Tricks?

Adding Pay-for-Performance Program to Routine Care Was Related to a Lower Risk of Depression Among Type 2 Diabetes Patients in Taiwan

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