| 摘要: | Background and Aims:
Schizophrenia caused a significant burden of disease over time. Efficient strategies and regulations are needed to enhance schizophrenia management and reduction of healthcare resource utilization. Taiwanese government has implemented the pay-for-performance (P4P) programs since year 2001. The P4P program for schizophrenia was added since year 2010. Due to the inconsistent results from previous studies in Taiwan and the fact that the latest data used was from nearly 10 years ago in 2013, this study was intended to evaluate the impacts of the P4P program on healthcare resource utilization of patients with schizophrenia and its related factors using more recent data, to further clarify the effectiveness of Taiwan’s P4P program for schizophrenia.
Methods:
This study carried out a secondary data analysis using Taiwan’s National Health Insurance Research Database (NHIRD) with a retrospective cohort design. Patients holding a schizophrenia catastrophic illness card were selected from the NHIRD between year 2009 to 2017. Patients were divided into the P4P group (exposed) and non-P4P group (unexposed). Double propensity score adjustment was performed with a ratio of one patient in the exposed group to four patients in the unexposed group based on matching criteria of age and gender. Generalized estimating equation models with the difference-in-differences methods were employed to estimate the effects of the P4P program for schizophrenia on enrollee’s healthcare resource utilization.
Results:
2,275 patients in the P4P group and 5,689 patients in the non-P4P group were obtained in this study. One-year participation in the P4P program was associated with a less likelihood of visiting the outpatient department (IRR = 0.8144, p < 0.0001). However, joining the P4P program did not have any significant effect on decreasing emergency room visits (IRR = 1.0330, p = 0.6573), hospital admissions (IRR = 0.9969, p = 0.9308), and length of stay (IRR = 1.1679, p = 0.3621) over time. In addition, healthcare resource utilization was influenced by patient characteristics (comorbidities, monthly insurance premium, and geographic area), physician
characteristics (gender and specialist seniority), and healthcare institution characteristics
(accreditation level and teaching status).
Conclusion:
This study demonstrated that P4P programs for schizophrenia were associated with fewer outpatient visits. However, there was no association between enrolment in the P4P program for schizophrenia and a reduction in emergency room visits, hospital admissions, or length of stay. Various strategies such as the widespread availability of community mental health services, promotion of family-based treatment modalities, and proper follow-up after discharge, could be undertaken to complement the P4P program for schizophrenia. |
