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Kuo WY, Tsai WC, Kung PT. Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program. Healthcare (Basel) 2023; 11:2742. [PMID: 37893816 PMCID: PMC10606631 DOI: 10.3390/healthcare11202742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVES This study's objectives were to compare the participation rates of people with and without disabilities who had type 2 diabetes in a diabetes pay-for-performance (DM P4P) program, as well as their care outcomes after participation. METHODS This was a retrospective cohort study. The data came from the disability registry file, cause of death file, and national health insurance research database of Taiwan. The subjects included patients newly diagnosed with type 2 diabetes between 2001 and 2013 who were followed up with until 2014 and categorized as disabled and non-disabled patients. The propensity score matching method was used to match the disabled with the non-disabled patients at a 1:1 ratio. Conditional logistic regression analysis was used to determine the odds ratio between the disabled and non-disabled patients who joined the P4P program. The Cox hazard model was used to compare the risk of dialysis and death between the disabled and non-disabled patients participating in the P4P program. RESULTS There were 110,645 disabled and 110,645 non-disabled individuals after matching. After controlling for confounding factors, it was found that the disabled individuals were significantly less likely (odds ratio = 0.89) to be enrolled in the P4P program than the non-disabled individuals. The risk of dialysis was 1.08 times higher for people with disabilities than those without, regardless of their participation in the P4P program. After enrollment in the P4P program, the risk of death for people with disabilities decreased from 1.32 to 1.16 times that of persons without disabilities. Among the people with disabilities, the risk of death for those enrolled in the P4P program was 0.41 times higher than that of those not enrolled. The risk of death was reduced to a greater extent for people with disabilities than for those without disabilities upon enrollment in the DM P4P program. CONCLUSION People with disabilities are less likely to be enrolled in the P4P program in Taiwan and have unequal access to care. However, the P4P program was more effective at reducing mortality among people with disabilities than among those without.
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Affiliation(s)
- Wei-Yin Kuo
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung 406040, Taiwan; (W.-Y.K.); (W.-C.T.)
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
| | - Pei-Tseng Kung
- Department of Medical Research, China Medical University Hospital, Taichung 404332, Taiwan
- Department of Healthcare Administration, Asia University, Taichung 413305, Taiwan
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Sung MC, Chung KP, Cheng SH. Impact of a diabetes pay-for-performance program on nonincentivized mental disorders: a panel study based on claims database analysis. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:41. [PMID: 37415154 DOI: 10.1186/s12962-023-00450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Diabetes is one of the most prevalent chronic diseases with subsequent complications. The positive effects of diabetes pay-for-performance (P4P) programs on treatment outcomes have been reported. The program provides financial incentives based on physiological care indicators, but common mental disorder complications such as depression are not covered. METHODS This study employed a natural experimental design to examine the spillover effects of diabetes P4P program on patients with nonincentivized depressive symptoms. The intervention group consisted of diabetes patients enrolled in the DM P4P program from 2010 to 2015. Unenrolled patients were selected by propensity score matching to form the comparison group. Difference-in-differences analyses were conducted to evaluate the effects of P4P programs. We employed generalized estimating equation (GEE) models, difference-in-differences analyses and difference-in-difference-in-differences analyses to evaluate the net effect of diabetes P4P programs. Changes in medical expenses (outpatient and total health care costs) over time were analysed for the treatment and comparison groups. RESULTS The results showed that enrolled patients had a higher incidence of depressive symptoms than unenrolled patients. The outpatient and total care expenses of diabetes patients with depressive symptoms were lower in the intervention group than in the comparison group. Diabetes patients with depressive symptoms enrolled in the DM P4P program had lower expenses for depression-related care than those not enrolled in the program. CONCLUSIONS The DM P4P program benefits diabetes patients by screening for depressive symptoms and lowering accompanying health care expenses. These positive spillover effects may be an important aspect of physical and mental health in patients with chronic disease enrolled in disease management programs while contributing to the control of health care expenses for chronic diseases.
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Affiliation(s)
- Ming-Chan Sung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Population Health Research Center, National Taiwan University, 17, Xu-Zhou Road, Taipei, 100, Taiwan.
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Lu CW, Wu YF, Chen TH, Chung CM, Lin CL, Lin YS, Chen MY, Yang YH, Lin MS. A nationwide cohort investigation on pay-for-performance and major adverse limb events in patients with diabetes. Prev Med 2021; 153:106787. [PMID: 34506818 DOI: 10.1016/j.ypmed.2021.106787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/18/2021] [Accepted: 09/04/2021] [Indexed: 11/19/2022]
Abstract
A retrospective cohort study was conducted using claims data from Taiwan's National Health Insurance program to assess the effect of diabetic pay-for-performance (P4P) program on major adverse limb events (MALE) and major adverse cardiovascular events (MACE) in patients with type 2 diabetes mellitus (T2DM). This study included patients with T2DM who had completed or not completed a 1-year P4P program from 2002 to 2013. Propensity-score matching was used to balance the baseline characteristics between groups. The Cox proportional-hazard model and Fine and Gray subdistribution hazard model were used to examine the association between P4P and the risks of MALE, MACE, systemic thromboembolism (ST), heart failure (HF) hospitalization, and all-cause mortality. Patients who underwent the P4P program had a significantly decreased incidence of MALE (2.0% vs. 2.6%, subdistribution hazard ratio [SHR] 0.73, 95% CI 0.71-0.76). Regarding the individual components, the P4P group demonstrated lower risks for foot ulcer (1.1% vs 1.3%, SHR 0.80, 95% CI 0.77-0.84), gangrene (0.57% vs 0.93%, SHR 0.59, 95% CI 0.56-0.63), percutaneous transluminal angioplasty (0.61% vs 0.79%, SHR 0.72, 95% CI 0.68-0.77), and amputation (0.46% vs 0.75%, SHR 0.58, 95% CI 0.55-0.62). In addition, the risks of MACE, ST, HF hospitalization, and all-cause mortality were remarkably lower in the P4P group. The P4P program might significantly reduce critical events of MALE, MACE, ST, HF, and mortality in the diabetic population.
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Affiliation(s)
- Cheng-Wei Lu
- Department of Family Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Fang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tien-Hsing Chen
- Department of Cardiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chang-Min Chung
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Liang Lin
- Department of Nephrology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mei-Yen Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan; Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shyan Lin
- Department of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taiwan.
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Huang HL, Kung CY, Wang SM, Kung PT, Lin YH, Chiu LT, Tsai WC. Effects of Body Mass Index and Pay-for-Performance Program on Risk of Death in Patients with Type 2 Diabetes: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094648. [PMID: 33925667 PMCID: PMC8125714 DOI: 10.3390/ijerph18094648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
Background: The diabetes patients enrolled in the pay-for-performance (P4P) program demonstrate reduced risk of death. Body mass index (BMI) is a risk factor of all-cause death. This study investigates the effects of BMI and P4P on the risk of death in type 2 diabetes patients. Methods: This is a retrospective cohort study. The study population includes the 3-wave National Health Interview Survey in Taiwan. A total of 6354 patients with diabetes aged ≥ 20 years were enrolled and followed up until the end of 2014. Results: The highest mortality rate per 1000 person-years was 61.05 in the underweight patients with diabetes. A lower crude death rate was observed in the P4P participants than non-P4P participants. The risk of death was 1.86 times higher in the underweight patients with diabetes than that in the normal weight group (95% CI: 1.37–2.53) and was lower in the P4P participants, as compared to the non-participants (HR: 0.55, 95% CI: 0.44–0.69). The most significant effect of joining the P4P program in reducing death risk was found in the underweight patients with diabetes (HR: 0.11, 95% CI: 0.04–0.38), followed by the obesity group (HR: 0.30, 95% CI: 0.17–0.52). Conclusions: Different effects of joining the P4P program on reducing death risk were observed in the underweight and obesity groups. We strongly recommend that patients with diabetes and without healthy BMIs participate in the P4P program.
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Affiliation(s)
- Hsiu-Ling Huang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Chuan-Yu Kung
- Department of Nursing, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu County 304, Taiwan; (H.-L.H.); (S.-M.W.)
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City 41354, Taiwan;
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City 40402, Taiwan
| | - Yen-Hsiung Lin
- Department of Pediatrics, Hengchun Tourism Hospital, Ministry of Health and Welfare, Pingtung County 94641, Taiwan;
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan;
- Correspondence: ; Tel.: +886-422994045; Fax: +886-422993643
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Rahman MK, Bhuiyan MA, Zailani S. Healthcare Services: Patient Satisfaction and Loyalty Lessons from Islamic Friendly Hospitals. Patient Prefer Adherence 2021; 15:2633-2646. [PMID: 34866903 PMCID: PMC8633710 DOI: 10.2147/ppa.s333595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The study has aimed to investigate the Muslim patient's psychological factors related to healthcare services that influence their loyalty intention for further treatment at private hospitals in Malaysia. METHODS Data were collected from private hospitals in Klang Valley. A total of 379 responses from patients were analysed using the structural equation modelling approach. RESULTS The findings revealed that administrative behaviour, nurse's services and Shariah amenities have a highly significant impact on satisfaction. The healthcare technicality, hospital environment and physician's services have a significant relationship with patient satisfaction. Patient satisfaction has a significant impact on patient loyalty to healthcare services at the hospital. Administrative behaviour, physicians' services and healthcare technicality have a direct and positive relationship with loyalty intention, while Shariah amenity has a negative significant relationship with loyalty. CONCLUSION The results have important implications for product development and managerial considerations in hospitals. Service providers need to be mindful that all aspects, including Shariah amenities and generic healthcare service delivery, are important and need to be balanced and delivered satisfactorily to ensure customer satisfaction.
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Affiliation(s)
- Muhammad Khalilur Rahman
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Pengkalan Chepa, 16100, Malaysia
| | - Miraj Ahmed Bhuiyan
- School of Economics, Guangdong University of Finance and Economics, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Miraj Ahmed Bhuiyan School of Economics, Guangdong University of Finance and Economics, 21 Luntou Road, Guangzhou, Guangdong, People’s Republic of China Email
| | - Suhaiza Zailani
- Faculty of Business and Accountancy, University of Malaya, Kuala Lumpur, Malaysia
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