title: Patient assessment of diabetes care in a pay-for-performance program.
abstract: OBJECTIVE
  Few studies address quality of care in pay-for-performance (P4P) programs from the perspective of patients' perceptions. This study aimed to examine and compare the patient assessment of diabetes chronic care as perceived by diabetic patients enrolled and not enrolled in a P4P program from the patients' self-reported perspectives.
  
  
  METHODS
  A cross-sectional study with case and comparison group design.
  
  
  METHODS
  A large-scale survey was conducted from February to November 2013 in 18 healthcare institutions in Taiwan.
  
  
  METHODS
  A total of 1458 P4P (n = 1037) and non-P4P (n = 421) diabetic patients participated in this large survey. The Chinese version of the Patient Assessment of Chronic Illness Care (PACIC) instrument was used and patients' clinical outcome data (e.g. HbA1c, LDL) were collected.
  
  
  METHODS
  None.
  
  
  METHODS
  Five subscales from the PACIC were measured, including patient activation, delivery system design/system support, goal setting/tailoring, problem solving/contextual and follow-up/coordination. Patient clinical outcomes were also measured. Multiple linear regression and logistic regression models were used and controlled for patient demographic and health institution characteristics statistically.
  
  
  RESULTS
  After adjusting for covariates, P4P patients had higher overall scores on the PACIC and five subscales than non-P4P patients. P4P patients also had better clinical processes of care (e.g. HbA1c test) and intermediate outcomes.
  
  
  CONCLUSIONS
  Patients who participated in the program likely received better patient-centered care given the original Chronic Care Model. Better perceptions of diabetic care assessment also better clinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care in a P4P program.
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan Research Education and Epidemiology Center, Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500-06, Taiwan.
authors.forename: Herng-Chia
authors.initials: HC
authors.lastname: Chiu
authors.affiliation: Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
authors.forename: Hui-Min
authors.initials: HM
authors.lastname: Hsieh
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
authors.forename: Yi-Chieh
authors.initials: YC
authors.lastname: Lin
authors.affiliation: Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500-06, Taiwan.
authors.forename: Shou-Jen
authors.initials: SJ
authors.lastname: Kuo
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
authors.forename: Hao-Yun
authors.initials: HY
authors.lastname: Kao
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan Department of Business Management, College of Management, National Sun Yat-sen University, 70 Lian Hai Road, Kaohsiung, 80424 Taiwan.
authors.forename: Shu-Chuan Jennifer
authors.initials: SC
authors.lastname: Yeh
authors.affiliation: MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei City 104, Taiwan.
authors.forename: Wen-Hsin
authors.initials: WH
authors.lastname: Chang
authors.affiliation: College of Medicine, Kaohsiung Medical University, Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.
authors.forename: Pi-Jung
authors.initials: PJ
authors.lastname: Hsiao
authors.affiliation: Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 813, Taiwan.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
authors.affiliation: President Superintendent, Choninn Healthcare System, No. 196, Sec. 1, Wenhua Rd., BanqiaoDist. New Taipei City 22041, Taiwan.
authors.forename: Shoei-Loong
authors.initials: SL
authors.lastname: Lin
authors.affiliation: E-DA Hospital; School of Medicine for International Students, I-Shou University 1 ,Yi-Da Road, Yanchao district, Kaohsiung, 82445 Taiwan.
authors.forename: Gin-Ho
authors.initials: GH
authors.lastname: Lo
authors.affiliation: Department of Surgery, Yuan's General Hospital, 162, Chen-Kong 1st Road, Kaohsiung 80249, Taiwan.
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.affiliation: Yuan's General Hospital, No. 162, Cheng gong 1st Road, Ling ya District, Kaohsiung City 80249, Taiwan.
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Hung
authors.affiliation: Department of Neurology, Yuan's General Hospital, 162, Chen-Kun 1st Road, Kaohsiung 80249, Taiwan.
authors.forename: Hsien-An
authors.initials: HA
authors.lastname: Cheng
authors.affiliation: Mennonite Christian Hospital, 44, Min-Chuan Road, Hualien 970, Taiwan.
authors.forename: Tiang-Hong
authors.initials: TH
authors.lastname: Chou
authors.affiliation: Cheng Ching General Hospital, 139 Ping Tien Street, Taichung, Taiwan.
authors.forename: Sze-Yuan
authors.initials: SY
authors.lastname: Chou
authors.affiliation: Department of Education and Research, Jiannren Hospital, 136 Nanyang Road, Kaohsiung 811, Taiwan.
authors.forename: Jao-Hsien
authors.initials: JH
authors.lastname: Wang
authors.affiliation: Division of Physical Therapy, Taitung Christian Hospital, 350 Kai-Feng Street, Taitung City, Taitung County 950, Taiwan.
authors.forename: Chien-Fu
authors.initials: CF
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000592:standards*; D011795:Surveys and Questionnaires; D013624:Taiwan
keywords: PACIC; chronic care model; diabetes care; patient-centered care; pay-for-performance