{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T09:05:15Z","timestamp":1767171915622,"version":"build-2238731810"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T00:00:00Z","timestamp":1654300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T00:00:00Z","timestamp":1654300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"abstract":"Abstracts<\/jats:title>\n \n Background<\/jats:title>\n Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models\u00a0to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (\n n<\/jats:italic>\n \u2009=\u2009153) was significantly lower than that of the non-P4P group (\n n<\/jats:italic>\n \u2009=\u20091663) (hazard ratio\u2009=\u20090.37, 95% CI\u2009=\u20090.31\u20130.43,\n p<\/jats:italic>\n \u2009<\u20090.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the\u00a0P4P group\u00a0was 0.35, (\n p<\/jats:italic>\n \u2009<\u20090.0001). With the low COCI (<\u20090.50) group as the reference, the aHR of LEA was 0.49 (\n p<\/jats:italic>\n \u2009<\u20090.0001) for the middle COCI group, (\n p<\/jats:italic>\n \u2009<\u20090.0001), and the aHR of LEA for the high COCI (\u2265 0.80) group was 0.23 (\n p<\/jats:italic>\n \u2009<\u20090.0001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically.<\/jats:p>\n <\/jats:sec>","DOI":"10.1186\/s12913-022-08075-2","type":"journal-article","created":{"date-parts":[[2022,6,4]],"date-time":"2022-06-04T14:02:28Z","timestamp":1654351348000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Pay-for-performance and continuity of care synergistically reduced amputation of lower extremity in patients with diabetes: a population-based cohort study"],"prefix":"10.1186","volume":"22","author":[{"given":"Yu-Ching","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Han","family":"Liao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li-Jung Elizabeth","family":"Ku","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jung-Der","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,4]]},"reference":[{"issue":"Suppl 2","key":"8075_CR1","doi-asserted-by":"publisher","first-page":"S60","DOI":"10.1016\/S1078-5884(11)60012-9","volume":"42","author":"M Lepantalo","year":"2011","unstructured":"Lepantalo M, Apelqvist J, Setacci C, Ricco JB, de Donato G, Becker F, et al. 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Ethics approval and consent to participate: The need for informed consent was waived by the Institutional Review Board of National Chung Kung University Hospital due to the use of claims data.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"748"}}