title: Factors related to continuing care and interruption of P4P program participation in patients with diabetes.
abstract: OBJECTIVE
  To examine factors that influenced continuing care participation in patients with diabetes and factors contributing to interrupted participation for patients with diabetes enrolled in a diabetes pay-for-performance (P4P) program in Taiwan.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  Data were obtained from Taiwan's National Health Insurance Research Database on patients with a new confirmed diagnosis of type 2 diabetes during 2001 to 2008, selected as 1:1 propensity score-matched P4P program enrollees and nonenrollees (totaling 396,830). Logistic regression was performed to analyze factors associated with continuing care participation and with interrupted P4P program participation after enrollment.
  
  
  RESULTS
  Among the patients with diabetes, P4P program enrollees were 4.27 times (95% CI, 4.19-4.36) more likely to participate in continuing care than nonenrollees. Factors affecting the participation of patients with diabetes in continuing care included P4P program enrollment status, personal characteristics, health status, characteristics of the main physician, and characteristics of the main healthcare organization. Interruption of P4P program participation occurred in 78,759 (44.33%) of the enrolled patients with diabetes and was correlated with male gender, younger age (< 35 years), residence in areas of highest urbanization, greater severity of diabetes complications, presence of catastrophic illness/injury, high service volume at the site of the main physician, older age (≥55 years) of the main physician, having a regional or private hospital as the main healthcare organization, and change of physician.
  
  
  CONCLUSIONS
  Taiwan's diabetes P4P program increased continuing care participation in patients with diabetes. The rate of interruption of P4P program participation among enrolled patients with diabetes, at 44.33%, should be a focus of improvement for Taiwan's health authorities.
authors.forename: Suh-May
authors.initials: SM
authors.lastname: Yen
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Sheen
authors.forename: Li-Ting
authors.initials: LT
authors.lastname: Chiu
authors.forename: Xing-Ci
authors.initials: XC
authors.lastname: Xu
authors.affiliation: 91 Hsueh-Shih Rd, Taichung, Taiwan 40402, Republic of China. E-mail: wtsai@mail.cmu.edu.tw.
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003266:Continuity of Patient Care; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010358:Patient Participation; D057216:Propensity Score; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology