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Pay-for-performance and continuity of care synergistically reduced amputation of lower extremity in patients with diabetes: a population-based cohort study.
- Source :
-
BMC Health Services Research . 6/4/2022, Vol. 22 Issue 1, p1-11. 11p. 1 Diagram, 3 Charts, 1 Graph. - Publication Year :
- 2022
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Abstract
- <bold>Background: </bold>Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.<bold>Methods: </bold>This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.<bold>Results: </bold>During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (n = 153) was significantly lower than that of the non-P4P group (n = 1663) (hazard ratio = 0.37, 95% CI = 0.31-0.43, p < 0.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the P4P group was 0.35, (p < 0.0001). With the low COCI (< 0.360) group as the reference, the aHR of LEA was 0.49 (p < 0.0001) for the middle COCI group, (p < 0.0001), and the aHR of LEA for the high COCI (≥0.643) group was 0.23 (p < 0.0001).<bold>Conclusions: </bold>Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 14726963
- Volume :
- 22
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- BMC Health Services Research
- Publication Type :
- Academic Journal
- Accession number :
- 157260432
- Full Text :
- https://doi.org/10.1186/s12913-022-08075-2