Effectiveness of Nationwide COPD Pay-for-Performance Program on COPD Exacerbations in Taiwan

Abstract

Shih-Lung Cheng,1,2,* Yi-Rong Li,3,* Nicole Huang,4 Chong-Jen Yu,5 Hao-Chien Wang,5 Meng-Chih Lin,6 Kuo-Chin Chiu,7 Wu-Huei Hsu,8 Chiung-Zuei Chen,9 Chau-Chyun Sheu,10,11 Diahn-Warng Perng,12 Sheng-Hao Lin,13 Tsung-Ming Yang,14 Chih-Bin Lin,15 Chew-Teng Kor,16 Ching-Hsiung Lin13,17,18 1Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 220, Taiwan; 2Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan, 320, Taiwan; 3Changhua Christian Hospital, Thoracic Medicine Research Center, Changhua, 500, Taiwan; 4Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan; 5Department of Internal Medicine, National Taiwan University Hospital, Taipei, 100, Taiwan; 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan; 7Division of Chest, Department of Internal Medicine, Poh-Ai Hospital, Luodong, 265, Taiwan; 8Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan; 9Division of Pulmonary Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, 701, Taiwan; 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan; 11Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan; 12Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, 112, Taiwan; 13Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan; 14Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, 613, Taiwan; 15Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970, Taiwan; 16Big Data Center, Changhua Christian Hospital, Changhua, Changhua Christian Hospital, Changhua, 500, Taiwan; 17Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, 402, Taiwan; 18Department of Recreation and Holistic Wellness, MingDao University, Changhua, 523, Taiwan*These authors contributed equally to this workCorrespondence: Ching-Hsiung LinDepartment of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua, 50006, TaiwanTel [phone]Fax [phone]Email [email protected]: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. It has also imposed a substantial economic and social burden on the health care system. In Taiwan, a nationwide COPD pay-for-performance (P4P) program was designed to improve the quality of COPD-related care by introducing financial incentives for health care providers and employing a multidisciplinary team to deliver guideline-based, integrated care for patients with COPD, reducing adverse outcomes, especially COPD exacerbation. However, the results of a survey of the effectiveness of the pay-for-performance program in COPD management were inconclusive. To address this knowledge gap, this study evaluated the effectiveness of the COPD P4P program in Taiwan.Methods: This retrospective cohort study used data from Taiwan’s National Health Insurance claims database and nationwide COPD P4P enrollment program records from June 2016 to December 2018. Patients with COPD were classified into P4P and non-P4P groups. Patients in the P4P group were matched at a ratio of 1:1 based on age, gender, region, accreditation level, Charlson Comorbidity Index (CCI), and inhaled medication prescription type to create the non-P4P group. A difference-in-difference analysis was used to evaluate the influence of the P4P program on the likelihood of COPD exacerbation, namely COPD-related emergency department (ED) visit, intensive care unit (ICU) admission, or hospitalization.Results: The final sample of 14,288 patients comprised 7144 in each of the P4P and non-P4P groups. The prevalence of COPD-related ED visits, ICU admissions, and hospitalizations was higher in the P4P group than in the non-P4P group 1 year before enrollment. After enrollment, the P4P group exhibited a greater decrease in the prevalence of COPD-related ED visits and hospitalizations than the non-P4P group (ED visit: − 2.98%, p< 0.05, 95% confidence interval [CI]: − 0.277 to − 0.086; hospitalization: − 1.62%, p< 0.05, 95% CI: − 0.232 to − 0.020), whereas no significant difference was observed between the groups in terms of the changes in the prevalence of COPD-related ICU admissions.Conclusion: The COPD P4P program exerted a positive net effect on reducing the likelihood of COPD exacerbation, namely COPD-related ED visits and hospitalizations. Future studies should examine the long-term cost-effectiveness of the COPD P4P program.Keywords: COPD, pay-for-performance program, guideline-based, comprehensive care, exacerbation, financial incentive

Keywords

• copd
• pay-for-performance program
• guideline-based
• comprehensive care
• exacerbation
• financial incentive