Abstract
BACKGROUND: Most patients with chronic kidney disease (CKD) benefit from early intervention programs designed to slow disease progression and reduce medical usage. The Early-CKD Pay-for-Performance (Early-CKD P4P) program, implemented by Taiwan's National Health Insurance Administration since 2011, has proven effective in this regard. However, there is limited research on outcomes for patients who interrupt their participation in the program. The study aimed to compare risks of emergency department visits, hospitalizations, and dialysis between those who continued versus those who interrupted the Early-CKD P4P program. METHODS: The study was a retrospective cohort study using nationwide data from Taiwan's National Health Insurance Research Database. We examined patients aged 18 and older who joined the Early-CKD P4P program between 2014 and 2016, with follow-up until the end of 2021. Propensity score matching ensured comparability between groups. Log-linear Poisson regression assessed emergency department visits and hospitalizations, while Cox proportional hazard models evaluated dialysis risk. RESULTS: A total of 100 228 participants joined the Early-CKD P4P program, with 37 457 in the continuous group and 62 771 in the interruption group, and 71 678 patients were matched. The patients who interrupted the program had significantly higher risks: emergency department visits were 3.41 times higher, hospitalizations 3.29 times higher, and the risk of dialysis was 5.46 times higher compared to the continuous group. CONCLUSIONS: Premature interruption of the Early-CKD P4P program is associated with significantly increased risks of adverse outcomes. Sustained engagement in the program is crucial to reduce disease progression and healthcare utilization. These findings highlight the critical importance of ongoing participation in the Early-CKD P4P program to reduce adverse health outcomes. For the high rate of interruption observed in the study, future policies should focus on developing and implementing effective strategies to improve patient retention and maximize the benefits of this public health program.