糖尿病患加入論質計酬方案對髖關節置換術後照護結果及相關因素探討

Effect of participation in pay-for-performance program on postoperative care outcomes in patients with diabetes undergoing hip replacement surgery

目標：糖尿病的高盛行率，已成為世界各國重視的慢性病之一。本研究探討糖尿病患加入論質計酬（pay-for-performance, P4P）方案對髖關節置換術後3日內再急診及14日內再住院風險及相關因素。方法：本研究為回溯性世代研究，利用健保資料庫篩選出研究對象，以傾向分數1：3配對（P4P vs. Non-P4P），取得基本特質與健康狀態相似之2組研究對象，共計12,440人（3,110 vs. 9,330）。除了描述性統計及雙變項分析外，利用廣義估計方程式（Generalized estimating equations, GEE）探討研究對象出院後再急診及再住院之勝算比及相關因素。結果：在未配對前，加入P4P者平均年齡較年輕（72.31±10.28 vs. 73.83±11.47, p<0.05）。配對後，加入P4P者較未加入者，有較低之再急診勝算比（aOR: 0.92），但未達顯著差異；有加入P4P者較未加入者，有較低之再住院勝算比（aOR: 0.7, 95% CI: 0.63-0.88），進一步分析發現，所有相關變項之各組別間，有加入P4P者均有較低之再住院率（p<0.05）。結論：加入P4P者有較佳之術後照護結果，建議糖尿病患均應積極加入P4P方案。本研究結果可作為糖尿病照護及P4P方案政策之參考。

Objectives: The increasing prevalence of diabetes worldwide represents a major chronic health concern. In this study, the effects of participation in a pay-for-performance (P4P) program on return visits to the emergency department within 3 days and readmission within 14 days after discharge were assessed in patients with diabetes undergoing hip replacement surgery. Related variables were also identified. Methods: This retrospective cohort study incorporated data from Taiwan’s National Health Insurance Research Database. Propensity score matching (1:3) was employed to create two groups (P4P and non-P4P) with similar baseline characteristics and health status. The final analysis included 12,440 patients (P4P, 3,110; non-P4P, 9,330). Descriptive statistics, bivariate analyses, and generalized estimating equations were used to identify odds ratios and factors linked to readmission and return visits to the emergency room after discharge. Results: Prior to matching, the P4P group had a younger average age than did the non-P4P group (P4P: 72.31±10.28 vs. non-P4P: 73.83±11.47 years; p < 0.05). After matching, the P4P group was less likely to return to the emergency department (aOR: 0.92) than was the non-P4P group, although this difference was nonsignificant. Notably, the P4P group had a significantly lower readmission rate (aOR: 0.7, 95% CI: 0.63–0.88) than did the non-P4P group. Further analysis confirmed that across all relevant variables, the P4P group consistently exhibited a lower readmission rate (p < 0.05). Conclusions: Participation in the P4P program resulted in better postoperative care outcomes. All patients with diabetes are recommended to join this program. The findings of this study can serve as a reference for diabetes care and P4P program development.