Is the pay-for-performance program associated with better quality of life among type 2 diabetes patients, including those with gastrointestinal conditions, in Taiwan? A cross-sectional survey

Abstract

Background Many studies have shown that Taiwan’s diabetes pay-for-performance (P4P) program can improve several patients’ clinical outcomes; however, it remains unclear whether P4P initiatives yield effects on health-related quality of life (HRQoL) for all diabetes patients as well as those with comorbidities, especially comorbid gastrointestinal conditions. Purpose In this study, we evaluated the effects of the diabetes P4P program on QoL among all patients as well as the effects of this program on QoL among patients with comorbid gastrointestinal conditions. Methods Data were collected across 6 hospitals. We used the five-level version of the EuroQol-5 Dimension (EQ-5D-5L) to obtain scores for health disutility. The scores for these measures were subsequently predicted via a generalized linear model (GLM) with a gamma distribution. We also applied propensity score weighting (PSW) to adjust for potential selection bias. Results After PSW, P4P program participation was found to be significantly correlated with lower EQ-5D disutility scores among all patients (parameter=−0.169, [−0.325, −0.012], P=0.034). Additionally, P4P program participation was significantly correlated with a lower EQ-5D disutility score among patients with comorbid gastrointestinal conditions (parameter=−0.604, [−0.891, −0.317], P<0.001). Conclusion Our findings suggest that participation in the diabetes P4P program is associated with improved HRQoL among all patients with type 2 diabetes, including those with gastrointestinal comorbidities. A P4P model incorporating continuing education, coordinated care, and regular follow-up may be particularly beneficial in enhancing HRQoL for patients with gastrointestinal complications.