# Use of the Pay-for-Performance Program in Reducing Sarcopenia Risk: A Nested Case–Control Study Among Patients with Type 2 Diabetes Mellitus

## TL;DR

This study shows that a pay-for-performance program can reduce the risk of sarcopenia in patients with type 2 diabetes.

## Contribution

The study is the first to demonstrate the effectiveness of P4P in preventing sarcopenia among T2DM patients.

## Key findings

- P4P participants had a 34% lower risk of sarcopenia compared to non-participants.
- Early enrollment in P4P within one year of diagnosis further reduced sarcopenia risk.
- High-intensity P4P participation was linked to even greater risk reduction.

## Abstract

Background and Objectives: Despite substantial advances in treatment strategies for patients with type 2 diabetes mellitus (T2DM), its complication, particularly sarcopenia, has emerged as a global healthcare challenge. Pay-for-performance (P4P), an incentive-based payment scheme, has long been used to improve the quality of care; however, few studies have explored its effect on sarcopenia prevention. Therefore, we conducted a nested case–control study to investigate the association between P4P participation and the risk of sarcopenia among patients with T2DM. Materials and Methods: Using a large claims dataset, we identified individuals aged 20–70 years with newly diagnosed T2DM between 2001 and 2010 in Taiwan. All enrollees were followed up until 2013 to determine the occurrence of sarcopenia. For each case, we randomly matched two controls without sarcopenia. The risk of sarcopenia in relation to P4P participation was estimated by fitting conditional logistic regression to yield the adjusted odds ratio (aOR) and corresponding 95% confidence interval (CI). Results: A total of 3475 individuals with sarcopenia and 6948 matched controls were included. Patients enrolled in the P4P program had a lower risk of sarcopenia than their matched counterparts (aOR = 0.66; 95% CI: 0.61–0.74). Earlier P4P enrollment (within 1 year of T2DM diagnosis) and high-intensity P4P participation were associated with additional reductions in sarcopenia risk. Conclusions: Integrating P4P into routine T2DM care may help prevent sarcopenia, highlighting the importance of interdisciplinary collaboration and timely program implementation.