The impact of pay-for-performance programs on hospitalization risks in subjects with type 1 diabetes mellitus: A nationwide cohort study.

Abstract

This retrospective cohort study aimed to investigate the impact of pay-for-performance programs (P4P) on hospitalization rates in individuals with type 1 diabetes mellitus (T1D). Using propensity score matching, we recruited 625 pairs of individuals with T1D with and without P4P care from the National Health Insurance Research Database of Taiwan between January 1, 2006, and December 31, 2018. The study used a multivariable Cox regression model to compare the risks of hospitalization for various reasons in individuals with T1D with and without P4P care. Individuals with T1D receiving pay-for-performance (P4P) care demonstrated a significantly lower risk of all-cause hospitalization (adjusted hazard ratio [aHR] 0.63, 95 % confidence interval [CI] 0.54-0.73). This reduction was particularly notable for hospitalizations related to glucose management or metabolic disorders, infectious diseases, pneumonia, circulatory and respiratory system diseases, and mental health, compared with those not receiving P4P care. However, no significant differences were observed in hospitalization risks for hyperglycemic crisis, severe hypoglycemia, or injury between individuals with and without P4P care. This nationwide cohort study found that P4P participation was associated with a lower risk of hospitalization in individuals with type 1 diabetes.