Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan
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RESEARCH ARTICLE
Open Access
Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan Jerry Che-Jui Chang1,2, Shinn-Jang Hwang3,4,5, Tzeng-Ji Chen3,4,5, Tai-Yuan Chiu1,2, Hsiao-Yu Yang6,7,8, Yu-Chun Chen4,5, Cheng-Kuo Huang3,9 and Chyi-Feng Jan1,3*
Abstract Background: The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. Methods: This population-based cohort study used Taiwan’s National Health Insurance Administration data on FPICP (fiscal year 2015–2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). Results: The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. Conclusion: Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR. Keywords: Quality of health care, Family practice integrated care project, Delivery of health care, Policy, Primary health care, Diabetes mellitus
Background Pay-for-performance (P4P) models, adopted by many countries worldwide, aim to improve healthcare quality by offering healthcare providers financial incentives based on performance indicators regarding the process of care, laboratory results, and clinical outcomes. P4P * Correspondence: [email protected] 1 Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei 100, Taiwan 3 Taiwan Association of Family Medicine, Taipei, Taiwan Full list of author information is available at the end of the article
programs have been found to benefit the process of care [1]; however, they differ from one program to another in terms of design, and the results generated by certain P4P programs do not necessarily remain valid in others. Therefore, it is essential that researchers evaluate the performance of P4P programs on a case-by-case basis. The Family Practice Integrated Care Project (FPICP) is a team-based integrated care program initiated in Taiwan in 2003, the year of severe acute respiratory syndrome (SARS) outbreak [2]. The SARS outbreak reflected the insufficiency of endemic disease preventive
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attributio
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