The association of clinical guideline adherence and pay-for-performance among patients with diabetes

J Chin Med Assoc. 2013 Feb;76(2):102-7. doi: 10.1016/j.jcma.2012.06.024. Epub 2012 Dec 23.


Background: Diabetes mellitus management is one of the most challenging health care issues in Taiwan. To improve guideline adherence and the quality of diabetes care, the diabetes mellitus pay-for-performance (DM-P4P) program was introduced in 2001. This study examined the effects of the DM-P4P program on guideline adherence among patients with diabetes.

Methods: This cross-sectional study used National Health Insurance (NHI) claim data to assess guideline adherence among three groups of patients with diabetes: patients enrolled in the DM-P4P program, patients not enrolled but treated by DM-P4P-participating physicians, and patients treated by non-P4P physicians. Guideline adherence measures included hemoglobin A1c, blood glucose, lipid, serum creatinine, alanine transaminase, urinalysis, and eye examinations. Multiple logistic regression with generalized estimated equation approach were used to assess the effect of the DM-P4P program while controlling for patient and physician characteristics.

Results: A total of 520,804 patients were included in the analysis. Patients enrolled in the DM-P4P program were more likely to receive all of the guideline-recommended tests/examinations than patients treated by non-P4P physicians. Patients who were not enrolled in the program but who were treated by DM-P4P-participating physicians were more likely to receive three of the seven recommended tests/examinations than were those treated by non-P4P physicians.

Conclusion: When physicians participated in the P4P program, this increased the likelihood that patients would receive guideline-recommended tests or examinations. Increasing the DM-P4P participation rates for physicians and patients are important and worthwhile objectives that can assist in the effort to more effectively manage diabetes in the general population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Diabetes Mellitus / therapy*
  • Female
  • Glycated Hemoglobin / analysis
  • Guideline Adherence*
  • Humans
  • Male
  • Middle Aged
  • Reimbursement, Incentive*


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human