Association Between A Pay-for-Performance Program, Process Quality and Avoidable Hospitalizations for Diabetes Care
Date Issued
2014
Date
2014
Author(s)
Tsai, Chien-Ju
Abstract
Background: The diabetes-related complications can be prevented from getting worse by quality of ambulatory care and proper treatment. Therefore, more and more studies are using avoidable hospitalizations as the measurement to evaluate the quality and the accessibility of primary care. However, a number of studies have examined the impacts of pay for performance programs on the process quality and healthcare utilization, but little is known about the quality measurement of outcome.
Objective: The study aimed to examine the association between a pay-for-performance program, process quality and avoidable hospitalizations for diabetes care. And to examine the effect of cross-level interaction between patient-level and physician-level on process quality.
Methods: A longitudinal cohort study with 3-year follow-up. New-onset diabetes patient were selected in 2004-2005 form National Health Insurance Research Database. Using generalized estimating equations to examine the association between the pay-for-performance program, process quality and avoidable hospitalizations for diabetes care after adjustment for the characteristics of patients. Furthermore, to examine weather process quality may mediate the relationship between the pay-for-performance program and avoidable hospitalizations. Finally, by using multilevel analysis, to examine the effect of cross-level interaction between patient-level and physician-level on process quality.
Results: Patients who participated in the pay-for-performance program have a lower probability of avoidable hospitalizations and have a better process quality of care. The patients who had a better process quality of care may also have a lower probability of avoidable hospitalizations. Patients’ quality of care on process may be influenced by primary care physicians'' gender, age, specialist and hospital. Primary care physicians'' specialist and hospital also have cross-level interaction on participating in the pay-for-performance.
Conclusions: Participating in the pay-for-performance program is an effective way to improve the process quality and to reduce the probability of avoidable hospitalizations for diabetes care. Had a better process quality may also reduce the probability of avoidable hospitalizations. Patients’ quality of care on process may be influenced by primary care physicians'' characteristics. In order to evaluate the effect of policy more deeply, further researches could quantify the severity of avoidable hospitalizations, like times, costs, etc.
Subjects
糖尿病論質計酬
照護過程品質
可避免住院
多層次分析
SDGs
Type
thesis
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