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. The author(s) received no financial support for the research, authorship, and/or publication of this article.
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
VL - 58
SP - 1517
EP - 1525
JO - Cleft Palate-Craniofacial Journal
JF - Cleft Palate-Craniofacial Journal
SN - 1055-6656
IS - 12
ER -