Table 1.

Access to Care—Patient‐Centered Research Questions in VHD

Disparities in care delivery What factors underlie disparities in care delivery (eg, echocardiographic surveillance according to guidelines and performance of valve repair/replacement at the appropriate time) for women, minorities, low‐income, and rural patients? How can those factors best be addressed and corrected? How do referral rates differ among various subgroups and why? Why is there a higher refusal rate for valve intervention among blacks? What alert systems (eg, echo parameter alert) would promote equitable, timely identification, and appropriate monitoring and treatment of VHD? How are Medicare coverage and reimbursement policies impacting access to available valve interventions, in general and among subgroups? Do current health insurance systems limit access?

Telemedicine How might telemedicine be employed to address challenges in the diagnosis and delivery of care for patients with significant VHD?

Heart valve centers What are the pros and cons, benefits, and costs of having valve care delivered via heart valve centers (concentrated expertise and procedures) vs a more disseminated model? Do heart valve centers have better clinical outcomes after adjustment for risk? How do patients weigh differences in outcomes between centers and the burden of travel to centers further from home? How aware are patients of the options available to them regarding where to receive care?

VHD indicates valvular heart disease.