The Impact of Pay-for-Performance Care on the Mortality and Cardiovascular Outcomes in Older Adults with Newly Diagnosed Type 2 Diabetes: A Nationwide Population-Based Cohort Study

Objectives: To evaluate the long-term effects of pay-for-performance (P4P) care in the geriatric population with newly diagnosed type 2 diabetes (T2D).

Design: Retrospective longitudinal cohort study.

Setting and participants: A total of 6607 propensity score-matched pairs of patients with newly diagnosed T2D who received either P4P care or standard care as identified from the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2019.

Methods: Cox regression models were used to assess differences in risk of outcomes between P4P and non-P4P care. Primary outcomes and measures include all-cause mortality, hospital admissions due to cardiovascular events, dialysis initiation, severe hyperglycemia, and severe hypoglycemia. Multivariable Cox regression models were performed to calculate hazard ratios among and within groups.

Results: The multivariable-adjusted model showed that patients with P4P care had a significantly lower risk of all-cause mortality [adjusted hazard ratio (aHR), 0.37; 95% CI, 0.35-0.39], stroke (aHR, 0.80 95% CI, 0.72-0.88), myocardial infarction (aHR, 0.57; 95% CI, 0.48-0.67), heart failure (aHR, 0.75; 95% CI, 0.69-0.81), and dialysis (aHR, 0.66; 95% CI, 0.53-0.82) compared with those not receiving P4P care. However, there were no significant differences in the risk of severe hyperglycemia (aHR, 0.92; 95% CI, 0.82-1.03) and severe hypoglycemia (aHR, 1.04; 95% CI, 0.92-1.17) between the 2 groups.

Conclusions and implications: This nationwide cohort study suggests that the P4P program may reduce the risk of cardiovascular events, dialysis needs, and mortality in older patients with T2D without increasing the risk of severe hypoglycemia. P4P may be an effective management strategy for older patients with T2D.