Long-term outcomes of the pay-for-performance program for patients with young-onset (20–40 years of age) type 2 diabetes

Aims: To investigate the long-term outcomes of Pay-for-Performance (P4P) care in patients with young-onset (20–40 years of age) diabetes (YOD). Methods: We recruited 3088 pairs of propensity-score matched patients with and without P4P care from the National Health Insurance Research Database between January 1, 2001, and December 31, 2017. The study used a multivariable Cox regression model to compare the risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes in YOD patients with and without P4P care. Results: The multivariable-adjusted model showed that patients with P4P care had significantly lower risks of mortality (aHR 0.31, 95% CI 0.25–0.38) and hospitalization for cardiovascular events (aHR 0.63, 95% CI 0.5–0.79) but a significantly higher risk of major microvascular outcomes (aHR 1.31, 95% CI 1.07–1.6). Patients with a longer cumulative duration of P4P and complete P4P care showed further lower risks of mortality, hospitalization for cardiovascular events, and major microvascular outcomes than those without P4P care. Conclusions: This nationwide cohort study showed that young-onset diabetes patients with P4P care had lower risks of death and cardiovascular events but a higher risk of major microvascular outcomes. However, patients with a longer duration of P4P care showed lower risks of these outcomes.