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

Devyani Chowdhury*, Mishaal Ather, Corey Snyder, Mallika Kodavatiganti, Fred Van Eenennaam, Karla Brigatti

Background: Value-based healthcare is a model proposed by Porter that aims to provide high quality care which is patient-centric and cost-effective. It recognizes unique needs of different populations and promotes healthcare provisions that are customized to their specific needs.

This study describes the family experiences and health seeking behaviors of insured and uninsured children who underwent cardiac surgery. Since the majority of the uninsured were Amish, the results can be extrapolated to them.

Methods: 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. In this study, most of the self-pay consisted of the Amish. The survey consisted 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.

Results: The self-pay reported fewer medical comorbidities and had lower utilization of healthcare than those who were insured; of which vision care, access to primary care and medical surgical specialty were significantly lower. The self-pay felt that they had better communication with the healthcare team and the family impact was discussed, whereas the insured felt that the short and long term goals were better defined. Stress was discussed more with the insured whereas difficulty in receiving care was discussed more with the self-pay. The self-pay did not have help with school issues or were offered services with the in-school team. Participation in health events and educational services were not offered to the self-pay.

Conclusion: The study reflects that the different populations have different needs that are important to them and this may be based on their cultural roots. One would expect that the self-pay Amish community would have greater comorbidities due to founder gene effect but those reported by patients were fewer. The cost of care for the self-pay Amish community may also have also influenced the utilization of services. This study indicates patient-centered outcomes vary among patient populations. This is influenced by their socio-cultural beliefs and resources. Care must be customized to meet the needs of the patients and the community.