Value-based cleft lip-cleft palate care: a progress report.
BACKGROUND
The health care debate in the United States centers on a concept that is fundamental to any service-based profession yet minimally integrated into the health care community: value creation. Value in health care has been defined as outcome achieved per dollar spent, and focuses on the patient. Many of the new strategies proposed to restructure health care delivery in the United States aim to study and improve both components of this equation. Indeed, it is a near guarantee that providers will soon be responsible for reporting their outcomes and resource use and will be benchmarked by these metrics. In addition, patients have a right to understand the value they receive from their care providers.


METHODS
In this report, the authors evaluate the current state of preparedness for the assessment of value in care delivery in the field of cleft lip-cleft palate based on literature review.


RESULTS
There has been important progress in the definition and assessment of basic outcomes in cleft lip-cleft palate care, largely through formation of intercenter collaborations. However, many fundamental challenges face the cleft community, especially in North America. Standardization of data collection and outcomes measurement and reporting are particularly lacking. In addition, few data exist regarding the cost of cleft care.


CONCLUSIONS
The weight of the evidence reveals that the cleft community is not prepared to assess, and thus improve, the value offered to patients. The authors address key challenges and outline future directions.
Abbott
Megan M
MM
Boston, Mass. From the Department of Plastic and Oral Surgery, Children's Hospital, and the Massachusetts Eye and Ear Infirmary.
Meara
John G
JG
D002648:Child; D002971:Cleft Lip / Q000191:economics / Q000601:surgery*; D002972:Cleft Palate / Q000191:economics / Q000601:surgery*; D003365:Costs and Cost Analysis; D005544:Forecasting; D006801:Humans; D017063:Outcome Assessment, Health Care
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