This study uses the health insurance claims database to
conduct a longitudinal analysis on the effects of both diabetes and
early CKD P4P programs. The Taiwan NHI implemented in 1995
covers more than 99% of the population. The P4P programs of
diabetes care and early CKD care were implemented in Taiwan in
2001 and 2010, respectively. There are explicit and rigorous
criteria for providers to recruit patients into P4P program in
Taiwan (Appendix 1, http://links.lww.com/MD/A869). The test
results of estimated glomerular filtration rate (eGFR) and urine
albuminuria and creatinine ratio (UACR or urine protein and
creatinine ratio [UPCR]) of each enrolled patient were examined
and recorded to ensure the appropriateness and fairness of
program execution. The data consisted of ambulatory care
records, inpatient care records, and administrative registration
files. In addition, the qualified physicians should receive at least
additional 6-hour CKD care training and be awarded previously at
least one of the specialties including renal, cardiology, metabolism,
internal medicine, surgeon, gynecology/obstetrics,
pediatrics, and family medicine. The program required physicians
to report eGFR and UACR (or UPCR) of each P4P enrolled
patient every 6 months. Additionally, the physicians are required
to provide annual evaluations for the enrolled patients, including a
management plan (such as goals, treatment, and monitoring
instructions), medical history, examinations, and biochemical
tests (including urine protein, urine creatinine, serum creatinine,
LDL, and HbA1c). The P4P program is to reward additional
health care fees of each recruited patient to the physician but not
depending on the patient’s renal progression.