英国唇腭裂儿童服务的集中化：一项基于医院住院统计数据的研究。
Centralisation of services for children with cleft lip or palate in England: a study of hospital episode statistics.
机构信息
Clinical Effectiveness Unit, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom.
出版信息
BMC Health Serv Res. 2012 Jun 10;12:148. doi: 10.1186/1472-6963-12-148.
BACKGROUND
In 1998, a process of centralisation was initiated for services for children born with a cleft lip or palate in the UK. We studied the timing of this process in England according to its impact on the number of hospitals and surgeons involved in primary surgical repairs.
METHODS
All live born patients with a cleft lip and/or palate born between April 1997 and December 2008 were identified in Hospital Episode Statistics, the database of admissions to English National Health Service hospitals. Children were included if they had diagnostic codes for a cleft as well as procedure codes for a primary surgical cleft repair. Children with codes indicating additional congenital anomalies or syndromes were excluded as their additional problems could have determined when and where they were treated.
RESULTS
We identified 10,892 children with a cleft. 21.0% were excluded because of additional anomalies or syndromes. Of the remaining 8,606 patients, 30.4% had a surgical lip repair only, 41.7% a palate repair only, and 28.0% both a lip and palate repair. The number of hospitals that carried out these primary repairs reduced from 49 in 1997 to 13, with 11 of these performing repairs on at least 40 children born in 2008. The number of surgeons responsible for repairs reduced from 98 to 26, with 22 performing repairs on at least 20 children born in 2008. In the same period, average length of hospital stay reduced from 3.8 to 3.0 days for primary lip repairs, from 3.8 to 3.3 days for primary palate repairs, and from 4.6 to 2.6 days for combined repairs with no evidence for a change in emergency readmission rates. The speed of centralisation varied with the earliest of the nine regions completing it in 2001 and the last in 2007.
CONCLUSIONS
Between 1998 and 2007, cleft services in England were centralised. According to a survey among patients' parents, the quality of cleft care improved in the same period. Surgical care became more consistent with current recommendations. However, key outcomes, including facial appearance and speech, can only be assessed many years after the initial surgical treatment.
背景
1998 年，英国启动了一项针对唇腭裂患儿服务的集中化进程。我们根据该进程对参与初次手术修复的医院和外科医生数量的影响，研究了这一进程在英格兰的时间进程。
方法
通过英国国民医疗服务体系医院入院数据库医院入院统计数据，确定了 1997 年 4 月至 2008 年 12 月间所有活产的唇裂和/或腭裂患儿。如果患儿存在诊断为唇腭裂的编码和初次手术修复的程序编码，则纳入研究。如果患儿的编码提示存在其他先天性异常或综合征，则将其排除在外，因为他们的其他问题可能决定了他们的治疗时间和地点。
结果
我们共确定了 10892 例唇腭裂患儿。21.0%的患儿因存在其他异常或综合征而被排除在外。在其余的 8606 例患儿中，30.4%仅接受了唇部手术修复，41.7%仅接受了腭部手术修复，28.0%同时接受了唇腭裂修复。实施这些初次修复手术的医院数量从 1997 年的 49 家减少到 2008 年的 13 家，其中 11 家医院在 2008 年至少为 40 名患儿实施了手术。负责手术的外科医生数量从 98 名减少到 26 名，其中 22 名医生在 2008 年至少为 20 名患儿实施了手术。在此期间，初次唇部修复术的平均住院时间从 3.8 天缩短至 3.0 天，初次腭部修复术的平均住院时间从 3.8 天缩短至 3.3 天，联合修复术的平均住院时间从 4.6 天缩短至 2.6 天，但急诊再入院率并无变化。集中化进程的速度因 9 个区域中最早于 2001 年完成的区域和最晚于 2007 年完成的区域而有所不同。
结论
1998 年至 2007 年间，英格兰的唇腭裂服务实现了集中化。根据对患儿家长的调查，同期唇腭裂治疗的质量有所提高。手术治疗变得更加符合当前的建议。然而，包括面部外观和言语在内的关键结果只能在初次手术治疗多年后才能评估。
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