價值為基礎的支付與糖尿病照護品質之關係

Association between value-based payments and quality of diabetic care

目標：過去研究指出醫療院所參與價值為基礎支付方案之數量及溢出效應也許會影響照護品質，因此本研究探討醫療院所參與價值為基礎支付方案數量和參與方案滲透率與糖尿病照護品質之相關性。方法：本研究為橫斷性研究，共納入7,136家照護糖尿病人的醫院與診所，採中央健康保險署醫療品質資訊公開網之糖尿病照護品質資料，針對三種價值為基礎的支付方案（糖尿病醫療給付改善方案、初期慢性腎臟病醫療給付改善方案及家庭醫師整合性照護計畫）及糖尿病醫療給付改善方案滲透率，在控制醫療機構特質與病人特性後，以多元線性迴歸探討自變項與糖尿病照護品質（醣化血紅素、空腹血脂、眼底、尿液蛋白質及血清肌酸酐等5項檢查率）之相關性。結果：當院所參與較多價值為基礎的方案，與較多的糖尿病照護品質指標較佳有關；糖尿病論質計酬滲透率愈高，與5項糖尿病照護品質指標愈佳有關。結論：參與多種價值為基礎的支付方案及較高滲透率都與較佳的糖尿病照護品質有關。

Objectives: Studies have indicated that the number of value-based payment (VBP) programs implemented by health-care facilities and the spill-over effects of such programs affect quality of care at these facilities. Therefore, this study examined how the number and the penetration rate for participation in VBP programs are associated with the quality of diabetes care. Methods: This cross-sectional study examined 7,136 hospitals and clinics in Taiwan that provide diabetes care. Using the Diabetes Care Quality Information from the Health-care Quality Information Disclosure Network, we examined the associations between various independent variables and the quality of diabetes care (based on the rates for HbA1c, fasting lipid profile, fundus, urine albumin, and creatinine screening); this was achieved by performing multiple linear regressions controlled for health-care facility characteristics and patient characteristics. The independent variables comprised several VBP programs (i.e., the diabetes mellitus pay-for-performance [P4P] system, early chronic kidney disease P4P programs, and Family Physician Integrated Care Program) and the penetration rate for the DM P4P programs. Results: The number of VBP programs that a facility participated in was positively associated with the quality of diabetes care. A higher penetration rate for the DM P4P programs was associated with the higher quality of diabetes care in terms of five quality indicators. Conclusions: Participation in multiple VBP programs and a high penetration rate for the DM P4P programs were associated with the improved quality of diabetes care.