Effect of participation in pay-for-performance program on postoperative care outcomes in patients with diabetes undergoing hip replacement surgery

Objectives: The increasing prevalence of diabetes worldwide represents a major chronic health concern. In this study, the effects of participation in a pay-for-performance (P4P) program on return visits to the emergency department within 3 days and readmission within 14 days after discharge were assessed in patients with diabetes undergoing hip replacement surgery. Related variables were also identified. Methods: This retrospective cohort study incorporated data from Taiwan’s National Health Insurance Research Database. Propensity score matching (1:3) was employed to create two groups (P4P and non-P4P) with similar baseline characteristics and health status. The final analysis included 12,440 patients (P4P, 3,110; non-P4P, 9,330). Descriptive statistics, bivariate analyses, and generalized estimating equations were used to identify odds ratios and factors linked to readmission and return visits to the emergency room after discharge. Results: Prior to matching, the P4P group had a younger average age than did the non-P4P group (P4P: 72.31 ± 10.28 vs. non-P4P: 73.83 ± 11.47 years; p < 0.05). After matching, the P4P group was less likely to return to the emergency department (aOR: 0.92) than was the non-P4P group, although this difference was nonsignificant. Notably, the P4P group had a significantly lower readmission rate (aOR: 0.7, 95% CI: 0.63–0.88) than did the non-P4P group. Further analysis confirmed that across all relevant variables, the P4P group consistently exhibited a lower readmission rate (p < 0.05). Conclusions: Participation in the P4P program resulted in better postoperative care outcomes. All patients with diabetes are recommended to join this program. The findings of this study can serve as a reference for diabetes care and P4P program development. (Taiwan J Public Health. 2025;44(1):57-70).