# Exploring the Glycemic Control of Pay-for-Performance Program for Psychiatric Patients With Diabetes in Real World: A Retrospective Quasiexperimental Study

## TL;DR

A pay-for-performance program improved blood sugar control in psychiatric patients with diabetes over a year.

## Contribution

Demonstrates that a diabetes pay-for-performance program improves glycemic control in psychiatric patients in real-world settings.

## Key findings

- The P4P group had a significant decrease in HbA1c levels over 12 months compared to an increase in the non-P4P group.
- Subgroup analysis showed greater HbA1c reduction in male patients and those with schizophrenia in the P4P group.
- The P4P program was associated with significantly better glycemic control in psychiatric diabetes patients.

## Abstract

Background: Psychiatric patients with Type 2 diabetes often experience suboptimal care and poor health outcomes.

Aims: This study is aimed at investigating the impact of a diabetes pay-for-performance (P4P) program on glycemic control in psychiatric patients with diabetes by comparing two regional psychiatric hospitals, one with the P4P program and one without.

Methods: We conducted a retrospective quasiexperimental study. A total of 149 psychiatric outpatients with Type 2 diabetes were enrolled in the P4P group, and 129 patients were in the non-P4P group. Hemoglobin A1c (HbA1c) values in the fourth quarter of 2018 served as baseline (before P4P implementation in either hospital). Follow-up HbA1c levels were collected at 3, 6, 9, and 12 months in 2019. Propensity score matching was performed based on baseline HbA1c to create comparable groups. Changes in HbA1c over 1 year were analyzed using paired and independent t-tests and a generalized estimating equation (GEE) model.

Result: The mean HbA1c level in the P4P group decreased progressively over 12 months (from 6.97% at baseline to 6.60%), whereas the non-P4P group showed an increase (from 7.00% to 7.12%). By the fourth quarter, the P4P group had a significantly lower mean HbA1c than the non-P4P group (p < 0.05). Subgroup analysis showed a greater HbA1c reduction in P4P participants who were male or had schizophrenia (p = 0.01 and p = 0.04, respectively).

Conclusions: The P4P program was associated with significantly improved glycemic control in psychiatric patients with diabetes compared to usual care. This integrated care model may be an effective strategy to improve diabetes outcomes in psychiatric populations.