The effectiveness of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes / 中华内分泌代谢杂志

ABSTRACT

Objective To evaluated the effectiveness and influence of a pay for performance incentive program on the comprehensive management in patients with type 2 diabetes. Methods The large-sample prospective study recruited 1359 eligible adult patients who were residents and had health record from three community health centers of Shanghai Jiading District. The method of randomized complete block design was used to classify the subjects into 4 groups. The physicians incentive group included 337 subjects, while the patients incentive group 338 subjects, the physicians and patients incentive group 331 subjects, the control group which the physicians and the patients would not have the incentive 353 subjects respectively. We established a cooperative pathway between community health care centers and general hospital, trained community health workers, equipped with the necessary clinical drugs, and finally, the Advance System for Diabetes Management system was used to carry out the tele-medicine. The type 2 diabetes mellitus patients, which were set goal in blood glucose and blood pressure control, managed by the general practitioners, the daily health behavior of the patients were regulated. All subjects in the patients incentive groups received the incentives if they can obtain or/and maintain the ideal level of HbA1C during the 2-years study period. The control group would not receive any incentives but would be provided with diabetes education booklet and group educational courses for diabetes mellitus control as usual. Results After 12 months and 24 months, HbA1C , systolic blood pressure, diastolic blood pressure, total cholesterol, fasting blood glucose in the four groups were all lower than baseline levels (P<0. 05), while the time of related exercise parameters and the rate of HbA1C achieving target in the study groups were higher than baseline (P<0. 05). Besides, the time of related exercise, time of moderate exercise intensity, time of strenuous exercise intensity, and the rate of HbA1C achieving target ( after 24 months49. 0％, 53. 2％, 51. 8％, 54. 4％, P<0. 05 ) had statistical significance among the physicians incentive, the patients incentive, the physicians and patients incentive, and the control groups. Logistic regression analysis showed that the duration of diabetes, the baseline HbA1C , whether using the insulin, taking hypoglycemic drugs are the main factors of the study with statistical significance (all P<0. 05). Conclusions Based on general practitioners-specialist cooperation tele-medicine, by regulating the daily health behavior and using the intervention of pay for performance, the new diabetes care model could improve the treatment effect of type 2 diabetes to some extent, especially the exercise time and its intensity. Besides, the duration of diabetes, the baseline of HbA1C , the using of insulin and hypoglycemic drugs turned out to be the main factors of the study.