Pay For Performance Reduces Incident Ulceration, Amputation, Death in the Diabetic Foot: Nationwide Study

A key Taiwanese nationwide study suggests that focusing on quality can improve outcomes. See for yourself:

A nationwide cohort investigation on pay-for-performance and major adverse limb events in patients with diabetes

A nationwide cohort investigation on pay-for-performance and major adverse limb events in patients with diabetes

Highlights

1. The nationwide population-base investigation unlinked vascular benefit of diabetic Pay-for-Performance (P4P).
2. Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) emerged to be critical in T2DM.
3. Diabetic P4P had a comprehensive cardiovascular protection on MALEs, MACEs, heart failure and mortality.

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.