A value of less than .05 was considered significant. Table 1 Patient and Health Care Institution Characteristics Among P4P and Non-P4P Individuals With Type 2 Diabetes, Taiwan ValueValue .001) by several characteristics (Table 1). associated with lower risks of malignancy incidence and SRPKIN-1 cancer-specific mortality. Summary Our findings provide evidence of the potential good thing about diabetes P4P programs in reducing risks of all-cause mortality and competing causes of death attributable to cancer-specific and diabetes-related mortality among type 2 diabetes individuals. Intro Diabetes mellitus and malignancy are common, severe global health problems that contribute considerably to health care costs. A 2014 statement from your International Diabetes Federation estimated that more than 387 million people worldwide have diabetes, and by 2035 this quantity will rise to 592 million; 4.9 million deaths and at least US $612 billion in health expenditure resulted from diabetes in 2014 (1). Diabetes is considered a strong self-employed predictor of vascular diseases (2). Growing evidence suggests a possible association between diabetes (especially type 2 diabetes) and site-specific malignancy risks (eg, liver, breast, colorectal), as well as malignancy mortality (3,4). Even though causal mechanisms for the association between diabetes and malignancy are not obvious, potential risk factors common to both are identified, including demographic (age, sex, race/ethnicity), genetic, and lifestyle-related (obesity, diet, physical activity, tobacco or alcohol usage) risk factors. Potential mechanisms for any possible biologic link SRPKIN-1 between diabetes and malignancy include insulin resistance, hyperinsulinemia, hyperglycemia, and chronic swelling (5,6). Most empirical studies focus on analyzing the intervention effect of glucose-lowering medication therapies (metformin, thiazolidinediones, sulfonylureas) on malignancy risks or malignancy prognosis, which in turn may influence cancer-specific mortality. However, the results regarding associations with malignancy risk are combined (3C5). Additional studies examined primarily the association between solitary healthy lifestyle choices (excess weight control, healthy diet, physical activity) and the SRPKIN-1 risks of particular types of malignancy (5,7). To the best of our knowledge, few studies possess investigated the degree to TSPAN3 which integrated interventions through a comprehensive and multidisciplinary diabetes management system might mitigate malignancy risks and malignancy mortality. Pay-for-performance (P4P) or value-based purchasing programs have been embraced by many developed nations like a tactical tool to stimulate delivery of long-term, multidisciplinary diabetes management and to allow expense of less money on incentives while efficiently improving diabetes care quality (8C10). For example, the United Kingdoms Quality and Outcome Platform and Australias P4P system pay bonuses to incentive improvements in care for diabetes individuals (9,11). In Taiwan, a diabetes P4P system was implemented nationwide by Taiwans National Health Insurance Administration (NHIA) at the end of 2001 to provide comprehensive diabetes management by following a American Diabetes Associations clinical practice recommendations (12). Comprehensive care through diabetes P4P programs may enhance quality of care and prevent or delay vascular complications (12,13) or reduce risks of all-cause mortality in individuals with diabetes (13). However, evidence of whether comprehensive diabetes care through a P4P system has any effect on incidence of types of malignancy, or competing risks for cancer-specific or diabetes-related death, is limited. This study targeted to examine the effects of comprehensive diabetes care offered through a nationwide diabetes P4P system in Taiwan on risks of malignancy incidence and mortality among individuals with type 2 diabetes. We hypothesized that modifying lifestyle-related risk factors with a comprehensive diabetes P4P system or administration of glucose-lowering medication therapies may prevent or delay incident tumor. We carried out an observational treatment and assessment cohort study using data from 3 longitudinal population-based databases in Taiwan to examine the degree to which the P4P system and additional risk factors were associated with malignancy incidence and competing causes of death (cancer-specific and diabetes-related) in individuals with type 2 diabetes who enrolled in the P4P system compared with a group of diabetes individuals who did not participate. Methods A diabetes P4P system was implemented by Taiwans NHIA in 2001 to improve the quality of health care for diabetes individuals. The program consists of several features (12). First, individuals with diabetes who have at least 2 outpatient appointments within 3 months in the same health care institution are eligible to enroll in the P4P system..