effect of a pay-for-performance program on renal outcomes among patients with early-stage chronic kidney disease in taiwan

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.