TY - JOUR
T1 - Evaluation of Discipline-Specific Outcomes Through a Multidisciplinary Team Clinic for Patients With Isolated Cleft Palate
AU - Trivedi, Prerak B.
AU - Padovano, William M.
AU - Skolnick, Gary B.
AU - Menezes, Maithilee D.
AU - Grames, Lynn M.
AU - Cheung, Susan
AU - Kim, Andrew M.
AU - Cradock, Mary M.
AU - Naidoo, Sybill D.
AU - Snyder-Warwick, Alison K.
AU - Patel, Kamlesh B.
N1 - Funding Information:
The first author was supported by Washington University in St. Louis School of Medicine Dean’s Fellowship through the Office of Medical Student Research.
Publisher Copyright:
© 2021, American Cleft Palate-Craniofacial Association.
PY - 2021/11
Y1 - 2021/11
N2 - Objective: To describe the incidence and timing of provider-specific interventions for children with isolated cleft palate. Design: This was a retrospective cohort study involving review of medical records. Setting: Multidisciplinary team care clinic at a tertiary academic children’s hospital between January 2000 and July 2019. Patients: Patients with isolated nonsyndromic cleft palate seen by an American Cleft Palate-Craniofacial Association-approved team; 138 children were included. Main Outcome Measures: Study outcomes included incidence of secondary velopharyngeal management, tympanostomy tube insertion, speech therapy, hearing loss, dental/orthodontic treatment, and psychology interventions. Provider-specific outcomes were calculated for patients at ages 0 to 3, 3 to 5, and >5 years. Results: Median follow-up time was 7.0 years (interquartile range: 3.3-11.8 years). At their last team assessment, 42% of patients still had conductive hearing loss. The rate of tympanostomy tube insertions not done alongside a palatoplasty was highest for ages 3 to 5 and dropped after new American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines in 2013 (P =.015); 54% of patients received speech-language therapy during follow-up. Palatoplasty, psychology, and dental/orthodontic treatment were all less common than speech or ENT treatment (P <.01). Secondary palatoplasty was performed in 31 patients (22%). Patients who received speech, dental/orthodontic, or psychology intervention followed up longer than those who did not (9.8 vs 2.1 years, P <.001). Conclusion: Half of the patients terminated team follow-up by age 7, suggesting that burden of care outweighed perceived benefits of continued follow-up for many families. These results can be used to adjust protocols for children with isolated cleft palate.
AB - Objective: To describe the incidence and timing of provider-specific interventions for children with isolated cleft palate. Design: This was a retrospective cohort study involving review of medical records. Setting: Multidisciplinary team care clinic at a tertiary academic children’s hospital between January 2000 and July 2019. Patients: Patients with isolated nonsyndromic cleft palate seen by an American Cleft Palate-Craniofacial Association-approved team; 138 children were included. Main Outcome Measures: Study outcomes included incidence of secondary velopharyngeal management, tympanostomy tube insertion, speech therapy, hearing loss, dental/orthodontic treatment, and psychology interventions. Provider-specific outcomes were calculated for patients at ages 0 to 3, 3 to 5, and >5 years. Results: Median follow-up time was 7.0 years (interquartile range: 3.3-11.8 years). At their last team assessment, 42% of patients still had conductive hearing loss. The rate of tympanostomy tube insertions not done alongside a palatoplasty was highest for ages 3 to 5 and dropped after new American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines in 2013 (P =.015); 54% of patients received speech-language therapy during follow-up. Palatoplasty, psychology, and dental/orthodontic treatment were all less common than speech or ENT treatment (P <.01). Secondary palatoplasty was performed in 31 patients (22%). Patients who received speech, dental/orthodontic, or psychology intervention followed up longer than those who did not (9.8 vs 2.1 years, P <.001). Conclusion: Half of the patients terminated team follow-up by age 7, suggesting that burden of care outweighed perceived benefits of continued follow-up for many families. These results can be used to adjust protocols for children with isolated cleft palate.
KW - ethics/health policies
KW - nonsyndromic clefting
KW - palatoplasty
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=85100599695&partnerID=8YFLogxK
U2 - 10.1177/1055665621990174
DO - 10.1177/1055665621990174
M3 - Article
C2 - 33535807
AN - SCOPUS:85100599695
SN - 1055-6656
VL - 58
SP - 1517
EP - 1525
JO - Cleft Palate-Craniofacial Journal
JF - Cleft Palate-Craniofacial Journal
IS - 12
ER -