Patients with diabetes in pay-for-performance programs have better physician continuity of care and survival

Am J Manag Care. 2017 Feb 1;23(2):e57-e66.


Objectives: This study investigated the effects of physician continuity, measured as the Continuity of Care Index (COCI) score, on the survival of patients with diabetes, including both pay-for-performance (P4P) participants and nonparticipants.

Study design: This was a retrospective, nationwide population-based analysis of 396,838 patients with diabetes, with 198,419 subjects each in the P4P participant and nonparticipant groups, from 1997 to 2009, in Taiwan.

Methods: The data presented in this study are secondary data obtained from the 1997 to 2009 National Health Insurance Research Database published by the Taiwan National Health Research Institute. Survival status and physician continuity were the dependent variables. Multiple regression analysis was used to examine the factors related to physician continuity among patients with diabetes. The Cox proportional hazard model was used to explore the related factors that affected the survival status of the patients with diabetes.

Results: After controlling for the other related factors, the COCI score of the P4P participants was 0.227 higher than that of the nonparticipants (P <.05). Compared with patients with a low COCI score (≤50%), the hazard ratio (HR) of mortality of patients with a high COCI score (>50%) was 0.47 (95% confidence interval [CI], 0.46-0.48). Compared with nonparticipants, the HR of mortality of P4P participants was 0.43 (95% CI, 0.41-0.44).

Conclusions: Patients with diabetes with higher physician continuity had a lower HR of mortality. P4P participants had higher physician continuity and a lower HR of mortality.

MeSH terms

  • Adult
  • Aged
  • Continuity of Patient Care*
  • Diabetes Mellitus / mortality*
  • Diabetes Mellitus / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Reimbursement, Incentive*
  • Retrospective Studies
  • Survival Analysis
  • Taiwan