Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan
Background With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2022-08-01
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| Series: | International Journal of Health Policy and Management |
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| Online Access: | https://www.ijhpm.com/article_4030_f4aa3c4986f58f647eb31555cbeb8860.pdf |
| _version_ | 1811158719181881344 |
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| author | Min-Ting Lin Chien-Ning Hsu Chien-Te Lee Shou-Hsia Cheng |
| author_facet | Min-Ting Lin Chien-Ning Hsu Chien-Te Lee Shou-Hsia Cheng |
| author_sort | Min-Ting Lin |
| collection | DOAJ |
| description | Background With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression. Methods We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) 2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray’s test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs. Results The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P < .0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58–0.64, P < .0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54–0.67, P < .0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. Conclusion The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD. |
| first_indexed | 2024-04-10T05:28:53Z |
| format | Article |
| id | doaj.art-3f9df8b37275487e99df3fba29128956 |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:28:53Z |
| publishDate | 2022-08-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-3f9df8b37275487e99df3fba291289562023-03-07T09:11:26ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-08-011181307131510.34172/ijhpm.2021.274030Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in TaiwanMin-Ting Lin0Chien-Ning Hsu1Chien-Te Lee2Shou-Hsia Cheng3Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, TaiwanDepartment of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanDivision of Nephrology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, TaiwanInstitute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, TaiwanBackground With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression. Methods We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) 2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray’s test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs. Results The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P < .0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58–0.64, P < .0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54–0.67, P < .0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. Conclusion The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD.https://www.ijhpm.com/article_4030_f4aa3c4986f58f647eb31555cbeb8860.pdfpay-for-performancechronic kidney diseasecohort studyrenal outcomeelectronic medical recordstaiwan |
| spellingShingle | Min-Ting Lin Chien-Ning Hsu Chien-Te Lee Shou-Hsia Cheng Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan International Journal of Health Policy and Management pay-for-performance chronic kidney disease cohort study renal outcome electronic medical records taiwan |
| title | Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan |
| title_full | Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan |
| title_fullStr | Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan |
| title_full_unstemmed | Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan |
| title_short | Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan |
| title_sort | effect of a pay for performance program on renal outcomes among patients with early stage chronic kidney disease in taiwan |
| topic | pay-for-performance chronic kidney disease cohort study renal outcome electronic medical records taiwan |
| url | https://www.ijhpm.com/article_4030_f4aa3c4986f58f647eb31555cbeb8860.pdf |
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