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Long-term outcomes of the pay-for-performance program for patients with young-onset (20–40 years of age) type 2 diabetes

  • Fu-Shun Yen
    Affiliations
    Dr. Yen’s Clinic, No. 15, Shanying Road, Gueishan District, Taoyuan 33354, Taiwan
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  • James Cheng-Chung Wei
    Affiliations
    Institute of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Jianguo, N. Rd., South District, Taichung City 40201, Taiwan

    Department of Medicine, Chung Shan Medical University Hospital, No. 110, Sec. 1, Jianguo, N. Rd., South District, Taichung City 40201, Taiwan

    Graduate Institute of Integrated Medicine, China Medical University, No.91, Hsueh-Shih, Road, Taichung 40402, Taiwan
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  • Yu-Tung Hung
    Affiliations
    Management Office for Health Data, China Medical University Hospital, 3F., No.373-2, Jianxing, Road, Taichung 4045, Taiwan

    College of Medicine, China Medical University, No. 110, Sec. 1, Jianguo, N. Rd., South District, Taichung City 40201, Taiwan
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  • Chih-Cheng Hsu
    Correspondence
    Corresponding authors.
    Affiliations
    Institute of Population Health Sciences, National Health Research Institutes, 35, Keyan Road, Zhunan, Miaoli County 35053, Taiwan

    Department of Health Services Administration, China Medical University, No.91, Hsueh-Shih Road, Taichung 40402, Taiwan

    Department of Family Medicine, Min-Sheng General Hospital, 168, ChingKuo Road, Taoyuan 33044, Taiwan

    National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
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  • Chii-Min Hwu
    Correspondence
    Corresponding authors.
    Affiliations
    Department of Medicine, National Yang-Ming Chiao Tung University School of Medicine, No.155, Sec.2, Linong Street, Taipei 11221, Taiwan

    Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Road, Beitou District, Taipei 11217, Taiwan
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Published:October 28, 2022DOI:https://doi.org/10.1016/j.diabres.2022.110136

      Highlights

      • Patients with P4P care show a lower risk of death.
      • Patients with P4P care show a lower risk of cardiovascular events.
      • Patients with a longer cumulative duration of P4P care show a lower risk of major microvascular outcomes.
      • P4P program may be beneficial for patients with YOD.

      Abstract

      Aims

      To investigate the long-term outcomes of Pay-for-Performance (P4P) care in patients with young-onset (20–40 years of age) diabetes (YOD).

      Methods

      We recruited 3088 pairs of propensity-score matched patients with and without P4P care from the National Health Insurance Research Database between January 1, 2001, and December 31, 2017. The study used a multivariable Cox regression model to compare the risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes in YOD patients with and without P4P care.

      Results

      The multivariable-adjusted model showed that patients with P4P care had significantly lower risks of mortality (aHR 0.31, 95% CI 0.25–0.38) and hospitalization for cardiovascular events (aHR 0.63, 95% CI 0.5–0.79) but a significantly higher risk of major microvascular outcomes (aHR 1.31, 95% CI 1.07–1.6). Patients with a longer cumulative duration of P4P and complete P4P care showed further lower risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes than those without P4P care.

      Conclusions

      This nationwide cohort study showed that young-onset diabetes patients with P4P care had lower risks of death and cardiovascular events but a higher risk of major microvascular outcomes. However, patients with a longer duration of P4P care showed lower risks of these outcomes.

      Keywords

      Abbreviations:

      YOD (young-onset diabetes), P4P (Pay-for-Performance), T2D (type 2 diabetes)
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