Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Participants
2.2. Description of Variables
2.3. Statistical Analysis
3. Results
3.1. Results of Matching between Disabled and Non-Disabled Diabetic Patients
3.2. Comparison of Enrollment in the P4P Program among Diabetic Patients with and without Disabilities
3.3. Effects of Enrollment in the DM P4P Program on the Risk of Dialysis in Disabled and Non-Disabled Diabetic Patients
3.4. Effects of the DM P4P Program on the Mortality in Disabled and Non-Disabled Diabetic Patients
4. Discussion
4.1. Disabled People Had a Lower Rate of Enrollment in the P4P Program than Non-Disabled People
4.2. The Similar Effects of the P4P Program on Reducing the Risk of Dialysis among DM Patients with Disabilities and Those without Disabilities
4.3. P4P Program Enrollment Reduced the Risk of Death More for Disabled Individuals than for Non-Disabled
5. Conclusions
6. Limitations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Before Matching | SMD * | After 1:1 Matching | SMD | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total (N = 1,730,891) | Non-Disabled (n = 1,620,246) | Disabled (n = 110,645) | Total (N = 221,290) | Non-Disabled (n = 110,645) | Disabled (n = 110,645) | ||||||||||
N | % | n | % | n | % | N | % | n | % | n | % | ||||
Sex | |||||||||||||||
Female | 803,979 | 46.45 | 755,536 | 46.63 | 48,443 | 43.78 | −0.057 | 96,886 | 43.78 | 48,443 | 43.78 | 48,443 | 43.78 | 0.000 | |
Male | 926,912 | 53.55 | 864,710 | 53.37 | 62,202 | 56.22 | 0.057 | 124,404 | 56.22 | 62,202 | 56.22 | 62,202 | 56.22 | 0.000 | |
Age (years) | |||||||||||||||
<45 | 289,012 | 16.70 | 275,097 | 16.98 | 13,915 | 12.58 | −0.124 | 27,826 | 12.57 | 13,911 | 12.57 | 13,915 | 12.58 | 0.000 | |
45~54 | 448,953 | 25.94 | 427,542 | 26.39 | 21,411 | 19.35 | −0.168 | 42,825 | 19.35 | 21,414 | 19.35 | 21,411 | 19.35 | 0.000 | |
55~64 | 438,980 | 25.36 | 416,713 | 25.72 | 22,267 | 20.12 | −0.134 | 44,534 | 20.12 | 22,267 | 20.12 | 22,267 | 20.12 | 0.000 | |
65~74 | 325,298 | 18.79 | 301,210 | 18.59 | 24,088 | 21.77 | 0.079 | 48,176 | 21.77 | 24,088 | 21.77 | 24,088 | 21.77 | 0.000 | |
≥75 | 228,648 | 13.21 | 199,684 | 12.32 | 28,964 | 26.18 | 0.357 | 57,929 | 26.18 | 28,965 | 26.18 | 28,964 | 26.18 | 0.000 | |
Average age (SD) | 58.26 (14.15) | 57.92 (13.98) | 63.27 (15.57) | 0.897 | 62.24 (15.29) | 62.10 (15.09) | 63.27 (15.57) | 0.102 | |||||||
CCI | |||||||||||||||
0 | 911,154 | 52.64 | 872,021 | 53.82 | 39,133 | 35.37 | −0.378 | 78,266 | 35.37 | 39,133 | 35.37 | 39,133 | 35.37 | 0.000 | |
1 | 428,741 | 24.77 | 401,390 | 24.77 | 27,351 | 24.72 | −0.001 | 54,702 | 24.72 | 27,351 | 24.72 | 27,351 | 24.72 | 0.000 | |
2 | 197,119 | 11.39 | 179,242 | 11.06 | 17,877 | 16.16 | 0.149 | 35,754 | 16.16 | 17,877 | 16.16 | 17,877 | 16.16 | 0.000 | |
≥3 | 193,877 | 11.20 | 167,593 | 10.34 | 26,284 | 23.76 | 0.363 | 52,568 | 23.76 | 26,284 | 23.76 | 26,284 | 23.76 | 0.000 | |
DCSI | |||||||||||||||
0 | 1,390,678 | 80.34 | 1,316,387 | 81.25 | 74,291 | 67.14 | −0.327 | 148,583 | 67.14 | 74,292 | 67.14 | 74,291 | 67.14 | 0.000 | |
1 | 170,318 | 9.84 | 159,034 | 9.82 | 11,284 | 10.20 | 0.013 | 22,568 | 10.20 | 11,284 | 10.20 | 11,284 | 10.20 | 0.000 | |
2 | 132,930 | 7.68 | 114,382 | 7.06 | 18,548 | 16.76 | 0.303 | 37,096 | 16.76 | 18,548 | 16.76 | 18,548 | 16.76 | 0.000 | |
≥3 | 36,965 | 2.14 | 30,443 | 1.88 | 6522 | 5.89 | 0.209 | 13,043 | 5.89 | 6521 | 5.89 | 6522 | 5.89 | 0.000 |
Total | Non-Disabled | Disabled | Non-Disabled | Disabled | P4P Program Participation | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Total | Total | Non P4P | P4P | Non P4P | P4P | |||||||||||||
N | % | N | % | n | % | n | % | n | % | n | % | aOR | 95% CI | p Value | ||||
Total | 221,290 | 110,645 | 100.00 | 110,645 | 100.00 | 84,954 | 76.78 | 25,691 | 23.22 | 88,391 | 79.89 | 22,254 | 20.11 | |||||
Non-disabled | 110,645 | 110,645 | 100.00 | - | - | - | - | - | - | - | - | - | - | 1.00 | ||||
Disabled | 110,645 | - | - | 110,645 | 100.00 | - | - | - | - | - | - | - | - | 0.89 | 0.87 | 0.91 | <0.001 | |
P4P | ||||||||||||||||||
Non-P4P | 173,345 | 84,954 | 76.78 | 88,391 | 79.89 | 84,954 | 76.78 | 25,691 | 23.22 | - | - | - | - | |||||
P4P | 47,945 | 25,691 | 23.22 | 22,254 | 20.11 | - | - | - | - | 88,391 | 79.89 | 22,254 | 20.11 | |||||
Sex | ||||||||||||||||||
Female | 96,886 | 48,443 | 43.78 | 48,443 | 43.78 | 37,349 | 77.10 | 11,094 | 22.90 | 38,866 | 80.23 | 9577 | 19.77 | 1.00 | ||||
Male | 124,404 | 62,202 | 56.22 | 62,202 | 56.22 | 47,605 | 76.53 | 14,597 | 23.47 | 49,525 | 79.62 | 12,677 | 20.38 | 1.07 | 1.05 | 1.1 | <0.001 | |
Age (years) | ||||||||||||||||||
<45 | 27,826 | 13,911 | 12.57 | 13,915 | 12.58 | 9528 | 68.49 | 4383 | 31.51 | 9795 | 70.39 | 4120 | 29.61 | 1.00 | ||||
45~54 | 42,825 | 21,414 | 19.35 | 21,411 | 19.35 | 14,913 | 69.64 | 6501 | 30.36 | 15,205 | 71.01 | 6206 | 28.99 | 0.92 | 0.89 | 0.95 | <0.001 | |
55~64 | 44,534 | 22,267 | 20.12 | 22,267 | 20.12 | 15,989 | 71.81 | 6278 | 28.19 | 16,657 | 74.81 | 5610 | 25.19 | 0.81 | 0.78 | 0.84 | <0.001 | |
65~74 | 48,176 | 24,088 | 21.77 | 24,088 | 21.77 | 18,652 | 77.43 | 5436 | 22.57 | 19,779 | 82.11 | 4309 | 17.89 | 0.74 | 0.71 | 0.77 | <0.001 | |
≥75 | 57,929 | 28,965 | 26.18 | 28,964 | 26.18 | 25,872 | 89.32 | 3093 | 10.68 | 26,955 | 93.06 | 2009 | 6.94 | 0.43 | 0.41 | 0.46 | <0.001 | |
Average age (SD) | 63.11 (15.3) | 62.95 (15.09) | 63.27 (15.57) | 64.44 (15.25) | 58.03 (13.43) | 64.92 (15.65) | 56.71 (13.38) | |||||||||||
Monthly salary (TWD) | ||||||||||||||||||
≤17,280 | 15,874 | 5307 | 4.8 | 10,567 | 9.55 | 4109 | 77.43 | 1198 | 22.57 | 8486 | 80.31 | 2081 | 19.69 | 1.00 | ||||
17,281~28,800 | 149,309 | 72,199 | 65.25 | 77,110 | 69.69 | 56,284 | 77.96 | 15,915 | 22.04 | 62,041 | 80.46 | 15,069 | 19.54 | 1.12 | 1.08 | 1.17 | <0.001 | |
28,801~45,800 | 35,743 | 20,432 | 18.47 | 15,311 | 13.84 | 14,844 | 72.65 | 5588 | 27.35 | 11,557 | 75.48 | 3754 | 24.52 | 1.21 | 1.15 | 1.27 | <0.001 | |
45,801~57,800 | 6787 | 4152 | 3.75 | 2635 | 2.38 | 3099 | 74.64 | 1053 | 25.36 | 2135 | 81.02 | 500 | 18.98 | 1.12 | 1.04 | 1.2 | 0.004 | |
≥57,801 | 13,442 | 8504 | 7.69 | 4938 | 4.46 | 6581 | 77.39 | 1923 | 22.61 | 4107 | 83.17 | 831 | 16.83 | 1.02 | 0.96 | 1.08 | 0.605 | |
Missing | 135 | 51 | 0.05 | 84 | 0.08 | |||||||||||||
Urbanization of residence area | ||||||||||||||||||
Level 1 | 51,731 | 30,061 | 27.17 | 21,670 | 19.59 | 23,437 | 77.96 | 6624 | 22.04 | 17,690 | 81.63 | 3980 | 18.37 | 1.00 | ||||
Level 2 | 62,011 | 32,674 | 29.53 | 29,337 | 26.51 | 24,822 | 75.97 | 7852 | 24.03 | 22,902 | 78.07 | 6435 | 21.93 | 1.19 | 1.15 | 1.22 | <0.001 | |
Level 3 | 34,346 | 17,565 | 15.88 | 16,781 | 15.17 | 13,482 | 76.75 | 4083 | 23.25 | 13,367 | 79.66 | 3414 | 20.34 | 1.17 | 1.13 | 1.21 | <0.001 | |
Level 4 | 38,983 | 17,010 | 15.37 | 21,973 | 19.86 | 12,788 | 75.18 | 4222 | 24.82 | 17,501 | 79.65 | 4472 | 20.35 | 1.36 | 1.31 | 1.41 | <0.001 | |
Level 5 | 7981 | 3251 | 2.94 | 4730 | 4.27 | 2613 | 80.38 | 638 | 19.62 | 3887 | 82.18 | 843 | 17.82 | 1.14 | 1.07 | 1.22 | <0.001 | |
Level 6 | 14,344 | 5603 | 5.06 | 8741 | 7.90 | 4390 | 78.35 | 1213 | 21.65 | 6950 | 79.51 | 1791 | 20.49 | 1.28 | 1.22 | 1.35 | <0.001 | |
Level 7 | 11,894 | 4481 | 4.05 | 7413 | 6.700 | 3422 | 76.37 | 1059 | 23.63 | 6094 | 82.21 | 1319 | 17.79 | 1.21 | 1.14 | 1.28 | <0.001 | |
Catastrophic illness | ||||||||||||||||||
No | 153,669 | 85,478 | 77.25 | 68,191 | 61.63 | 63,988 | 74.86 | 21,490 | 25.14 | 53,093 | 77.86 | 15,098 | 22.14 | 1.00 | ||||
Yes | 67,621 | 25,167 | 22.75 | 42,454 | 38.37 | 20,966 | 83.31 | 4201 | 16.69 | 35,298 | 83.14 | 7156 | 16.86 | 0.87 | 0.85 | 0.9 | <0.001 | |
CCI | ||||||||||||||||||
0 | 78,266 | 39,133 | 35.37 | 39,133 | 35.37 | 27,541 | 70.38 | 11,592 | 29.62 | 28,479 | 72.77 | 10,654 | 27.23 | 1.00 | ||||
1 | 54,702 | 27,351 | 24.72 | 27,351 | 24.72 | 20,694 | 75.66 | 6657 | 24.34 | 21,566 | 78.85 | 5785 | 21.15 | 1.08 | 1.04 | 1.13 | <0.001 | |
2 | 35,754 | 17,877 | 16.16 | 17,877 | 16.16 | 14,245 | 79.68 | 3632 | 20.32 | 14,892 | 83.30 | 2985 | 16.70 | 1.13 | 1.07 | 1.19 | <0.001 | |
≥3 | 52,568 | 26,284 | 23.76 | 26,284 | 23.76 | 22,474 | 85.50 | 3810 | 14.50 | 23,454 | 89.23 | 2830 | 10.77 | 1.01 | 0.95 | 1.07 | 0.875 | |
DCSI | ||||||||||||||||||
0 | 148,583 | 74,292 | 67.14 | 74,291 | 67.14 | 55,188 | 74.29 | 19,104 | 25.71 | 57,123 | 76.89 | 17,168 | 23.11 | 1.00 | ||||
1 | 22,568 | 11,284 | 10.2 | 11,284 | 10.2 | 8454 | 74.92 | 2830 | 25.08 | 8871 | 78.62 | 2413 | 21.38 | 1.05 | 1.01 | 1.09 | 0.009 | |
2 | 37,096 | 18,548 | 16.76 | 18,548 | 16.76 | 15,652 | 84.39 | 2896 | 15.61 | 16,470 | 88.80 | 2078 | 11.20 | 0.92 | 0.88 | 0.97 | <0.001 | |
≥3 | 13,043 | 6521 | 5.89 | 6522 | 5.89 | 5660 | 86.80 | 861 | 13.20 | 5927 | 90.88 | 595 | 9.12 | 0.85 | 0.79 | 0.92 | <0.001 | |
Hypertension | ||||||||||||||||||
No | 44,134 | 22,603 | 20.43 | 21,531 | 19.46 | 17,385 | 76.91 | 5218 | 23.09 | 17,135 | 79.58 | 4396 | 20.42 | 1.00 | ||||
Yes | 177,156 | 88,042 | 79.57 | 89,114 | 80.54 | 67,569 | 76.75 | 20,473 | 23.25 | 71,256 | 79.96 | 17,858 | 20.04 | 1.21 | 1.18 | 1.25 | <0.001 | |
Hyperlipidemia | ||||||||||||||||||
No | 86,266 | 37,485 | 33.88 | 48,781 | 44.09 | 32,923 | 87.83 | 4562 | 12.17 | 44,085 | 90.37 | 4696 | 9.63 | 1.00 | ||||
Yes | 135,024 | 73,160 | 66.12 | 61,864 | 55.91 | 52,031 | 71.12 | 21,129 | 28.88 | 44,306 | 71.62 | 17,558 | 28.38 | 2.65 | 2.58 | 2.72 | <0.001 | |
Physician volume | ||||||||||||||||||
Low (<Q1) | 9027 | 4401 | 3.98 | 4626 | 4.18 | 3280 | 74.53 | 1121 | 25.47 | 3579 | 77.37 | 1047 | 22.63 | 1.00 | ||||
Median (Q3~Q1) | 60,701 | 29,614 | 26.76 | 31,087 | 28.1 | 23,120 | 78.07 | 6494 | 21.93 | 25,078 | 80.67 | 6009 | 19.33 | 1.00 | 0.95 | 1.06 | 0.977 | |
High (>Q3) | 151,562 | 76,630 | 69.26 | 74,932 | 67.72 | 58,554 | 76.41 | 18,076 | 23.59 | 59,734 | 79.72 | 15,198 | 20.28 | 1.09 | 1.03 | 1.15 | 0.002 | |
Healthcare organization level | ||||||||||||||||||
Medical center | 44,734 | 23,619 | 21.35 | 21,115 | 19.08 | 18,983 | 80.37 | 4636 | 19.63 | 17,177 | 81.35 | 3938 | 18.65 | 1.00 | ||||
Regional hospital | 67,861 | 32,044 | 28.96 | 35,817 | 32.37 | 24,019 | 74.96 | 8025 | 25.04 | 27,963 | 78.07 | 7854 | 21.93 | 1.31 | 1.27 | 1.35 | <0.001 | |
District hospital | 51,314 | 23,008 | 20.79 | 28,306 | 25.58 | 18,121 | 78.76 | 4887 | 21.24 | 23,688 | 83.69 | 4618 | 16.31 | 1.01 | 0.98 | 1.05 | 0.540 | |
Community clinic | 52,800 | 30,408 | 27.48 | 22,392 | 20.24 | 22,553 | 74.17 | 7855 | 25.83 | 16,934 | 75.63 | 5458 | 24.37 | 0.90 | 0.87 | 0.93 | <0.001 | |
Missing | 4581 | 1566 | 1.42 | 3015 | 2.72 | |||||||||||||
Healthcare organization type | ||||||||||||||||||
Public | 8715 | 4805 | 4.34 | 3910 | 3.53 | 3264 | 67.93 | 1541 | 32.07 | 2630 | 67.26 | 1280 | 32.74 | 1.00 | ||||
Non-public | 212,575 | 105,840 | 95.66 | 106,735 | 96.47 | 81,690 | 77.18 | 24,150 | 22.82 | 85,761 | 80.35 | 20,974 | 19.65 | 0.57 | 0.54 | 0.61 | <0.001 |
Total | Non Dialysis | Dialysis | p Value | Risk of Dialysis # | ||||||||
N | % | n | % | n | % | aHR | 95% CI | p Value | ||||
Total | 221,290 | 100.00 | 217,255 | 98.18 | 4035 | 1.82 | ||||||
Status | 0.898 | |||||||||||
Non-disabled | 110,645 | 50.00 | 108,632 | 98.18 | 2013 | 1.82 | 1.00 | |||||
Disabled | 110,645 | 50.00 | 108,623 | 98.17 | 2022 | 1.83 | 1.08 | 1.01 | 1.15 | 0.026 | ||
P4P | <0.001 | |||||||||||
Non P4P | 173,345 | 78.33 | 170,000 | 98.07 | 3345 | 1.93 | 1.00 | |||||
P4P | 47,945 | 21.67 | 25,323 | 52.82 | 690 | 1.44 | 0.66 | 0.6 | 0.72 | <0.001 | ||
Status × P4P interaction term | 0.839 | |||||||||||
Total | Survival | Death | p Value | Risk of Death # | ||||||||
N | % | n | % | n | % | aHR | 95% CI | p Value | ||||
Total | 221,290 | 100.00 | 148,275 | 67.00 | 73,015 | 33.00 | ||||||
Status | <0.001 | |||||||||||
Non-disabled | 110,645 | 50.00 | 79,645 | 71.98 | 31,000 | 28.02 | 1.00 | |||||
Disabled | 110,645 | 50.00 | 68,630 | 62.03 | 42,015 | 37.97 | 1.34 | 1.32 | 1.36 | <0.001 | ||
P4P | <0.001 | |||||||||||
Non P4P | 173,345 | 78.33 | 106,230 | 61.28 | 67,115 | 38.72 | 1.00 | |||||
P4P | 47,945 | 21.67 | 42,045 | 87.69 | 5900 | 12.31 | 0.45 | 0.43 | 0.47 | <0.001 | ||
Status × P4P interaction term | <0.001 | 0.87 | 0.82 | 0.92 | <0.001 |
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Kuo, W.-Y.; Tsai, W.-C.; Kung, P.-T. Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program. Healthcare 2023, 11, 2742. https://doi.org/10.3390/healthcare11202742
Kuo W-Y, Tsai W-C, Kung P-T. Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program. Healthcare. 2023; 11(20):2742. https://doi.org/10.3390/healthcare11202742
Chicago/Turabian StyleKuo, Wei-Yin, Wen-Chen Tsai, and Pei-Tseng Kung. 2023. "Participation and Outcomes among Disabled and Non-Disabled People in the Diabetes Pay-for-Performance Program" Healthcare 11, no. 20: 2742. https://doi.org/10.3390/healthcare11202742