Leung Leslie Tze Fung, Loock Christine A, Courtemanche Rebecca, Courtemanche Douglas J
Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Developmental Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
Plast Surg (Oakv). 2019 Nov;27(4):311-318. doi: 10.1177/2292550319876664. Epub 2019 Sep 29.
A 2016 review of the BC Children's Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program's care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic.
Cross-sectional.
BC Children's Hospital Cleft Palate-Craniofacial Program.
Five hundred seventy-six waitlisted patients.
Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines.
Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis ( = .019), a need for formal speech assessments or evaluations ( < .001), or a requirement to see multiple specialists ( < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment.
Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.
2016年对卑诗省儿童医院腭裂-颅面项目（CPP）的一项综述显示，三分之一的患者符合该项目的护理建议，一半患者符合美国腭裂-颅面协会的指南。本研究对CPP等候名单上的患者进行了回顾，确定了中位等待时间和错过的临床评估，并确定了等待时间是如何受到医疗复杂性、专业言语服务需求、脆弱性以及与诊所距离的影响。
横断面研究。
卑诗省儿童医院腭裂-颅面项目。
576名列入等候名单的患者。
推荐预约日期后的额外等待时间。额外等待时间与诊断、所需专科医生数量、所需言语服务、脆弱性以及与诊所距离的相关性。根据CPP团队建议和ACPA指南错过的整形手术、言语和正畸评估。
患者的额外中位等待时间为11个月（四分位间距：5-27）。额外等待时间较长与颅面诊断（P = 0.019）、需要进行正式言语评估或评价（P < 0.001）或需要看多位专科医生（P < 0.001）相关。脆弱性和与诊所的距离不影响等待时间。45名（8%）患者在学龄前和青少年时期无法获得整形手术评估，355名（62%）患者无法获得言语评估，120名（21%）患者无法完成正畸评估。
患者等待长达一年时间才能接受CPP的诊治，并在关键发育里程碑错过言语、正畸和手术评估。需要额外资源来解决这些问题。
