參加論質計酬方案對糖尿病COVID-19患者重症及死亡之影響

Abstract

研究背景研究目的： 糖尿病不但顯著影響COVID-19患者的重症及死亡狀況，也增加入住加護病及使用呼吸器風險，雖多數Omicron感染者為輕症，但若患者具有糖尿病史，可能增加了患者的重症及死亡風險。本研究目的為探討參與糖尿病及初期慢性腎臟病照護整合方案，對於第一次感染COVID-19的糖尿病患者其死亡、臨床表現重症、入住加護病房、使用侵襲型呼吸器、重症結果是否有所影響。 研究方法： 透過健保資料庫蒐集2021年10月至2022年9月之間第一次確診COVID-19的糖尿病患者，依前一年度的人口學特徵、健康狀況、醫療資源使用做為影響參與論質計酬的控制變項，並使用傾向分數進行1：1配對，研究組及對照組均為122,514人，最後以羅吉斯迴歸分析各組不良健康事件發生風險。 研究結果： 參與論質計酬方案者，相對於未參加者發生不良健康事件風險可能性較低，其死亡危險對比值為0.54（95%CI：0.49-0.60）、臨床表現重症危險對比值0.55（95% CI：0.52-0.58）、入住加護病房危險對比值為0.61（95% CI：0.57-0.66）、使用侵襲性呼吸器危險對比值0.60（95% CI：0.54-0.67）、重症危險對比值為0.56（95% CI：0.53-0.59）。 結論： 糖尿病患者第一次確診COVID-19前一年度參與論質計酬方案，對於確診後30天內的重症及死亡事件，具有顯著保護效果。在未來鼓勵高風險族群參相關論質計酬方案，也建議發展不良健康事件預測模型，降低重症及死亡發生機會。

Background and Aims: Diabetes mellitus (DM) is associated with greater risk of COVID-19 severe illness and mortality, as well as increases the risk of admission to intensive care and the use of mechanical ventilation. Most COVID-19 patients infected with Omicron variant have mild symptoms. However, it may increase the risk of severe illness and mortality for those diabetes patients with COVID-19 infection. We aimed to analyze the association between pay-for-performance(P4P) program and outcomes of diabetic patients infected COVID-19, including mortality, severe illness, admission to intensive care unit, use of invasive ventilators, and adverse health events. Materials and Methods: In order to construct the intervention group, we selected COVID-19 patients with diabetes mellitus cases from NHI database from October 2021 to September 2022. By using the propensity score method to construct a comparable matching group , we selected the research group (N=122,514) and the control group (N=122,514) by matching their characteristics, health status and medical resources covariates relating to the probability of their participation in the program. Subsequently, we took logistics regression to compare the likelihood of risk of adverse health events among groups. Results: After matching , P4P group had a lower likelihood of adverse health events risk than non-P4P group with mortality odds ratio (OR) of 0.54 (95% CI: 0.49-0.60), severe illness odds ratio (OR) of 0.55 (95% CI: 0.52-0.58),admission to intensive care unit odds ratio (OR) of 0.61 (95% CI: 0.57-0.66),use of invasive ventilators odds ratio (OR) of 0.60 (95% CI: 0.54-0.67), adverse health events odds ratio (OR) of 0.56 (95% CI: 0.53-0.59). Conclusion: This study provides evidence that pay-for-performance program improved the outcomes after diabetic patients infected COVID-19 in Taiwan. Policymaker shoulder considers expanding P4P for diabetic patients in the post-pandemic era. We encourage high-risk groups to engage in P4P and recommend to develop prediction models of adverse health events.