Associations between participation in a diabetes pay-for-performance program and health outcomes and healthcare utilization among people with comorbid schizophrenia and type 2 diabetes in Taiwan

Objective: Few population-based studies with large sample sizes have examined the long-term effects of integrated diabetes care in patients with schizophrenia. This study aimed to examine the association between participation in the nationwide diabetes Pay-for-Performance (DM-P4P) program and both health outcomes and healthcare utilization in individuals with schizophrenia comorbid with type 2 diabetes in Taiwan. Study setting and design: This was a longitudinal, real-world, nested case-control follow-up study from 2015 to 2021 in Taiwan. Data source and analytical sample: Multiple national population-based databases were used, including Taiwanese population-based longitudinal National Health Insurance (NHI) claims database, registry for NHI enrollment, catastrophic illness registry, board-certificated specialist registry, and registry for health care facilities. A total of 6172 schizophrenia patients with type 2 diabetes and matched controls were compared on a set of process outcome, health utilization, and direct medical cost measures between DM-P4P and non-P4P patients, with a follow-up period of at least three years. Generalized linear regression models were used to investigate the factors influencing participation in the DM-P4P program and to compare health outcomes. Principle findings: Schizophrenia patients with more severe diabetes complications and chronic comorbid conditions, or those who had previously participated in a schizophrenia P4P program, were more likely to participate in the program. Those who participated in the DM-P4P program were more likely to receive regular diabetes check-ups, and to have had more DM-related outpatient visits but fewer emergency room visits, hospitalizations, and related expenditures, as well as lower all-cause mortality, than non-DM-P4P patients. Conclusions: The nationwide DM-P4P program positively affected health outcomes and healthcare utilization among people with schizophrenia comorbid with type 2 diabetes. Policymakers should consider establishing incentive mechanisms to encourage integrated care for schizophrenia patients with diabetes.