{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T15:01:53Z","timestamp":1768402913968,"version":"3.49.0"},"reference-count":39,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/501100007300","name":"China Medical University","doi-asserted-by":"publisher","award":["CMU106-S-19"],"award-info":[{"award-number":["CMU106-S-19"]}],"id":[{"id":"10.13039\/501100007300","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,23]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>A pay-for-performance (P4P) programme is a management strategy that encourages healthcare providers to deliver high quality of care. In Taiwan, the P4P programme has been implemented for diabetes, and certified diabetes physicians voluntarily enrol patients with diabetes into the P4P programme. The objectives of this study were to compare the risk of stroke and its related factors in patients with type 2 diabetes who were enrolled in a P4P programme compared with those who were not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>This study is a natural experiment in Taiwan. A retrospective cohort investigation was conducted from 2002 to 2013, which included 459\u2009726 patients with type 2 diabetes, who were grouped according to P4P enrolment status following a propensity score matching process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We reviewed patients \u226545 years of age newly diagnosed with type 2 diabetes mellitus (DM) from the National Health Insurance Research Database in Taiwan. A Cox proportional hazards model was used to compare the relative risk of stroke between patients with type 2\u2009DM enrolled in the P4P programme and those who were not enrolled.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared with the patients not enrolled, there was a significantly lower stroke risk in P4P participants (HR=0.97, 95%\u2009CI 0.95 to 0.99). Although a significantly lower risk of haemorrhagic stroke was observed (HR=0.87, 95%\u2009CI 0.82 to 0.93) in P4P participants, no statistically significant difference for the risk of ischaemic stroke between P4P and non-P4P patients (HR=0.99, 95%\u2009CI 0.97 to 1.02) was found. Following stratification analysis, a significantly reduced stroke risk was observed in male patients with type 2 diabetes, but not in women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Participants in Taiwan\u2019s Diabetes P4P programme displayed a significantly reduced stroke risk, especially haemorrhagic stroke. We recommend the continual promotion of this programme to the general public and to physicians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-026626","type":"journal-article","created":{"date-parts":[[2019,10,16]],"date-time":"2019-10-16T15:35:48Z","timestamp":1571240148000},"page":"e026626","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study"],"prefix":"10.1136","volume":"9","author":[{"given":"Chien-Wen","family":"Chou","sequence":"first","affiliation":[{"name":"Department of Health Services Administration, China Medical University, Taichung, Taiwan"},{"name":"Nantou Hospital, Ministry of Health and Welfare, Nantou, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pei-Tseng","family":"Kung","sequence":"additional","affiliation":[{"name":"Department of Healthcare Administration, Asia University, Taichung, Taiwan"},{"name":"Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wen-Yu","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9684-0789","authenticated-orcid":false,"given":"Wen-Chen","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration, China Medical University, Taichung, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,10,16]]},"reference":[{"key":"2025121515154800000_9.10.e026626.1","unstructured":"IDF Diabetes Atlas . 8Th edition. diabetes atlas website. 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Available: http:\/\/www.who.int\/mediacentre\/factsheets\/fs312\/en\/index.html [Accessed Retrieved December 1,2015]."},{"key":"2025121515154800000_9.10.e026626.3","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.641381"},{"key":"2025121515154800000_9.10.e026626.4","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1111\/dom.13248","article-title":"Effect of intensive blood pressure control in patients with type 2 diabetes mellitus over 9 years of follow-up: a subgroup analysis of high-risk ACCORDION trial participants","volume":"20","author":"Buckley","year":"2018","journal-title":"Diabetes Obes Metab"},{"key":"2025121515154800000_9.10.e026626.5","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1056\/NEJMoa1800256","article-title":"Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes","volume":"379","author":"Rawshani","year":"2018","journal-title":"New England Journal of Medicine"},{"key":"2025121515154800000_9.10.e026626.6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.116.308398"},{"key":"2025121515154800000_9.10.e026626.7","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.1332"},{"key":"2025121515154800000_9.10.e026626.8","unstructured":"Taiwan Ministry of Health and Welfare . 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