Patient assessment of diabetes care in a pay-for-performance program

Abstract

Objective: Few studies address quality of care in pay-for-performance (P4P) programs from the perspectiveof patients' perceptions. This study aimed to examine and compare the patient assessmentof diabetes chronic care as perceived by diabetic patients enrolled and not enrolled in a P4P programfrom the patients' self-reported perspectives.Design: A cross-sectional study with case and comparison group design.Setting: A large-scale survey was conducted from February to November 2013 in 18 healthcareinstitutions in Taiwan. Participants: A total of 1458 P4P (n = 1037) and non-P4P (n = 421) diabetic patients participated in thislarge survey. The Chinese version of the Patient Assessment of Chronic Illness Care (PACIC) instrumentwas used and patients' clinical outcome data (e.g. HbA1c, LDL) were collected.Intervention: None.Main Outcome Measures: Five subscales from the PACIC were measured, including patient activation,delivery system design/system support, goal setting/tailoring, problem solving/contextual andfollow-up/coordination. Patient clinical outcomes were also measured. Multiple linear regressionand logistic regression models were used and controlled for patient demographic and health institutioncharacteristics statistically.Results: After adjusting for covariates, P4P patients had higher overall scores on the PACIC and fivesubscales than non-P4P patients. P4P patients also had better clinical processes of care (e.g. HbA1ctest) and intermediate outcomes.Conclusions: Patients who participated in the program likely received better patient-centered caregiven the original Chronic Care Model. Better perceptions of diabetic care assessment also betterclinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care ina P4P program.