Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 8 2022 08 01 Effect of a Pay-for-Performance Program on Renal Outcomes Among Patients With Early-Stage Chronic Kidney Disease in Taiwan 1307 1315 4030 10.34172/ijhpm.2021.27 EN Min-Ting Lin Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan 0000-0002-3960-0877 Chien-Ning Hsu Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan 0000-0001-7470-528X Chien-Te Lee Division of Nephrology, Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan 0000-0002-4704-1956 Shou-Hsia Cheng Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan Population Health Research Center, National Taiwan University, Taipei, Taiwan 0000-0001-7630-9934 Journal Article 2020 07 17 Background With the promising outcomes of the pre-ESRD (end-stage renal disease) pay-for-performance (P4P) program, the National Health Insurance Administration (NHIA) of Taiwan launched a P4P program for patients with early chronic kidney disease (CKD) in 2011, targeting CKD patients at stages 1, 2, and 3a. This study aimed to examine the long-term effect of the early-CKD P4P program on CKD progression.  Methods  We conducted a matched cohort study using electronic medical records from a large healthcare delivery system in Taiwan. The outcome of interest was CKD progression to estimated glomerular filtration rate (eGFR) 2 between P4P program enrolees and non-enrolees. The difference in the cumulative incidence of CKD progression between the P4P and non-P4P groups was tested using Gray’s test. We adopted a cause-specific (CS) hazard model to estimate the hazard in the P4P group as compared to non-P4P group, adjusting for age, sex, baseline renal function, and comorbidities. A subgroup analysis was further performed in CKD patients with diabetes to evaluate the interactive effects between the early-CKD P4P and diabetes P4P programs.  Results  The incidence per 100 person-months of disease progression was significantly lower in the P4P group than in the non-P4P group (0.44 vs. 0.69, P < .0001), and the CS hazard ratio (CS-HR) for P4P program enrolees compared with non-enrolees was 0.61 (95% CI: 0.58–0.64, P < .0001). The results of the subgroup analysis further revealed an additive effect of the diabetes P4P program on CKD progression; compared to none of both P4P enrolees, the CS-HR for CKD disease progression was 0.60 (95% CI: 0.54–0.67, P < .0001) for patients who were enrolled in both early-CKD P4P and diabetes P4P programs. Conclusion  The present study results suggest that the early-CKD P4P program is superior to usual care to decelerate CKD progression in patients with early-stage CKD. https://www.ijhpm.com/article_4030_084a8a9aa8cced9175bd07bc44998e75.pdf