2048-P: Care Management Processes as Drivers of Diabetes Quality in Primary Care: Evidence from Taiwan’s National Pay-for-Performance Program

Introduction and Objective: Primary care clinics provide nearly half of diabetes care in Taiwan. While the national Diabetes Pay-for-Performance (P4P) program has achieved high uptake, the absence of standardized quality benchmarks may contribute to variable outcomes. Methods: A Taiwan-specific Primary Care Diabetes Quality Assessment Tool was adapted from the NCQA Physician Practice Connections-Readiness Survey using a two-round Delphi process (Kendall’s W = 0.320, p < 0.001). Clinic-level care management processes were assessed against established diabetes quality indicators. Results: Between March and October 2025, 100 primary care clinics participated. Among P4P clinics (n = 87), all reported multidisciplinary care teams. Adherence to guidelines exceeded 90%, and over 80% had implemented case management systems, structured follow-up, and shared decision-making workflows. Clinic size and P4P participation were key determinants of performance. Enrollment averaged 98.5% in P4P clinics. HbA1c and lipid testing rates exceeded 90% across all clinics. However, smaller clinics (<300 patients) showed significantly lower performance for retinal examination and urine microalbumin testing (both p < 0.001). Higher scores in information/follow-up and chronic disease management domains were associated with improved screening. No significant associations were found for poor glycemic control (HbA1c >9%). Conclusion: Taiwan’s diabetes P4P program is linked to high overall quality in primary care. Investments in information systems, follow-up, and chronic disease management infrastructure may reduce clinic-size disparities in microvascular complication screening and strengthen primary care-led diabetes management.