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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Health Services Research 1/2018

Pay for performance program reduces treatment needed diabetic retinopathy - a nationwide matched cohort study in Taiwan

BMC Health Services Research > Ausgabe 1/2018
Shwu-Jiuan Sheu, Wen-Liang Lin, Yea-Huei Kao Yang, Chi-Min Hwu, Ching-Lan Cheng
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12913-018-3454-6) contains supplementary material, which is available to authorized users.



Pay-for-Performance programs have shown improvement in indicators monitoring adequacy and target achievement in diabetic care. However, less is known regarding the impact of this program on the occurrence and long-term effects of diabetic retinopathy. The objective of this study was to determine the effect of pay-for-performance program on the development of treatment needed for diabetic retinopathy in type 2 diabetes patients.


We conducted a nationwide retrospective cohort study with a matching design using the Taiwan National Health Insurance Research Database from 2000 to 2012. The outcome was defined as the treatment needed diabetic retinopathy. We matched Pay-for-Performance and non-Pay-for-Performance groups for age, gender, year diabetes was diagnosed and study enrollment, and duration of follow-up.


A total of 9311 patients entered the study cohort, of whom 2157 were registered in the Pay-for-Performance group and 7154 matched in the non-Pay-for-Performance group. The incidence of treatment needed diabetic retinopathy was not significantly different in two groups. However, the incidence of treatment needed diabetic retinopathy was significantly different if restricted the non-Pay-for-Performance group who had at least 1 eye examination or optical coherence tomography within 1 year (adjusted hazard ratio, 0.78; 95% confidence interval, 0.64–0.94).


Pay-for-Performance is valuable in preventing the development of treatment needed diabetic retinopathy, which could be attributed to the routine eye examination required in the Pay-for-Performance program. We could improve our diabetic care by promoting eye health education and patient awareness on the importance of regular examinations.
Additional file 1: Table S1. Baseline characteristics of the cohort patients with type 2 diabetes using propensity score (DOCX 16 kb)
Additional file 2: Table S2. Incidence of diabetic retinopathy in eye examination groups compared with no eye examination groups among non-P4P population (check detection bias) (DOCX 15 kb)
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