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研究生(外文):Hong-Chia Chang
論文名稱(外文):Impact of Pay-for-Performance Program on Severe Illness and Mortality among COVID-19 Patients with Diabetes Mellitus
指導教授(外文):Yu-Chi Tung
口試委員(外文):Shou-Hsia ChengMing-Chin YangChun-Fu Lee
外文關鍵詞:pay-for-performancediabetes mellitusCOVID-19severe illnessmortality
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參與論質計酬方案者,相對於未參加者發生不良健康事件風險可能性較低,其死亡危險對比值為0.54(95%CI:0.49-0.60)、臨床表現重症危險對比值0.55(95% CI:0.52-0.58)、入住加護病房危險對比值為0.61(95% CI:0.57-0.66)、使用侵襲性呼吸器危險對比值0.60(95% CI:0.54-0.67)、重症危險對比值為0.56(95% CI:0.53-0.59)。
Background and Aims:
Diabetes mellitus (DM) is associated with greater risk of COVID-19 severe illness and mortality, as well as increases the risk of admission to intensive care and the use of mechanical ventilation. Most COVID-19 patients infected with Omicron variant have mild symptoms. However, it may increase the risk of severe illness and mortality for those diabetes patients with COVID-19 infection. We aimed to analyze the association between pay-for-performance(P4P) program and outcomes of diabetic patients infected COVID-19, including mortality, severe illness, admission to intensive care unit, use of invasive ventilators, and adverse health events.
Materials and Methods:
In order to construct the intervention group, we selected COVID-19 patients with diabetes mellitus cases from NHI database from October 2021 to September 2022. By using the propensity score method to construct a comparable matching group , we selected the research group (N=122,514) and the control group (N=122,514) by matching their characteristics, health status and medical resources covariates relating to the probability of their participation in the program. Subsequently, we took logistics regression to compare the likelihood of risk of adverse health events among groups.
After matching , P4P group had a lower likelihood of adverse health events risk than non-P4P group with mortality odds ratio (OR) of 0.54 (95% CI: 0.49-0.60), severe illness odds ratio (OR) of 0.55 (95% CI: 0.52-0.58),admission to intensive care unit odds ratio (OR) of 0.61 (95% CI: 0.57-0.66),use of invasive ventilators odds ratio (OR) of 0.60 (95% CI: 0.54-0.67), adverse health events odds ratio (OR) of 0.56 (95% CI: 0.53-0.59).
This study provides evidence that pay-for-performance program improved the outcomes after diabetic patients infected COVID-19 in Taiwan. Policymaker shoulder considers expanding P4P for diabetic patients in the post-pandemic era. We encourage high-risk groups to engage in P4P and recommend to develop prediction models of adverse health events.
口試委員會審定書 i
誌謝 ii
中文摘要 iii
Abstract iv
目錄 v
圖目錄 vii
表目錄 viii
第一章 緒論 1
第一節、研究背景與動機 2
第二節、研究目的 4
第三節、實習單位簡介 5
第二章 文獻探討 6
第一節 糖尿病及論質計酬計畫 7
第二節 嚴重特殊傳染性肺炎(COVID-19)介紹 10
第三節 糖尿病患者易發展至COVID-19重症可能原因 13
第四節 相關實證研究 15
第五節 綜合評論 21
第三章 研究方法 22
第一節 研究設計與架構 23
第二節 研究假說 25
第三節 研究對象 26
第四節 資料來源與資料處理流程 27
第五節 研究變項操作型定義 29
第六節 統計方法分析 33
第四章 研究結果 34
第一節 描述性統計 35
第二節 雙變項分析 45
第三節 多變項分析 64
第五章 討論 79
第一節 研究方法討論 80
第二節 研究結果討論 81
第三節 研究限制 90
第六章 結論與建議 91
第一節 結論 92
第二節 建議 93
參考文獻 95
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