Assessment of Value-Based Healthcare Delivery in Cardiac Care for Children of Amish Families

Abstract

Background Value-based healthcare is a prominent concept that focuses on patient health outcomes to ensure more efficient healthcare. This patient-centered approach can be applied to establish community-specific personalized care. Unique healthcare solutions need to be developed to adapt to the needs of specific populations. This study highlights the comparison of the delivery of care between the Amish and the Non-Amish community in children who have undergone cardiac surgery. Methods The results are interpreted to reflect areas of the healthcare delivery that lack value. Pediatric Integrated Care Survey (PICS) was sent to parents/guardians of 160 children who had undergone at least one cardiac surgery, and were followed at Cardiology Care for Children. Majority of the self-pay population consisted of the Amish. The survey consisted of 5 components: access, communication, family impact, goal creation and team functioning. Composite score calculation was done to gauge favorable responses. An independent sample t-test was conducted to assess the differences in patient-centered care, with a 95% confidence interval (p <0.05), between the insured and self-pay patients. Results The self-pay community reported fewer medical comorbidities and had a lower utilization of healthcare than those who were insured. Access to care was equally good in both groups. The self-pay group felt that they had better communication and family impact, whereas the insured group felt that the short and long term goals were better defined. The self-pay and the insured groups valued different components, reflecting different perceptions of healthcare. Conclusion The study suggests the need for innovations in the delivery of cardiac care for children of Amish families. Value and impact of care should be regularly addressed with both the providers and patients. Clear communication between physicians and patients is critical including establishing short and long-term goals. Decision-making should be equal amongst patients and their families. The role of the patients' families should be regularly addressed. Healthcare utilization, cost, and value should be recognized and addressed. Ultimately, a more efficient healthcare delivery system reduces cost for patients and creates high-value care.