Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications

A.R. Ness, A.K. Wills, O. Mahmoud, A. Hall, D. Sell, J. Smallridge, L. Southby, D. Stokes, S. Toms, A. Waylen, Y. Wren, J.R. Sandy

Research output: Contribution to journalSpecial issue

Abstract

Objectives: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK). Setting and sample population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. Materials and Methods: Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression. Results: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. Conclusions: Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.

Original languageEnglish
Pages (from-to)48-51
Number of pages4
JournalOrthodontics & craniofacial research
Volume20
Issue numberSuppl.S2
DOIs
Publication statusPublished - 1 Jun 2017

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Cleft Lip
Cleft Palate
Hearing Loss
Outcome Assessment (Health Care)
Topical Fluorides
Speech Intelligibility
Speech Therapy
Hearing Aids
Therapeutics
Fluorides
Self Report
Tablets
Population

Bibliographical note

© 2017 John Wiley & Sons A/S. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Keywords

  • centralization
  • cleft lip
  • cleft palate
  • outcomes
  • variation

Cite this

Ness, A.R. ; Wills, A.K. ; Mahmoud, O. ; Hall, A. ; Sell, D. ; Smallridge, J. ; Southby, L. ; Stokes, D. ; Toms, S. ; Waylen, A. ; Wren, Y. ; Sandy, J.R. / Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service : the Cleft Care UK study. Part 6: summary and implications. In: Orthodontics & craniofacial research. 2017 ; Vol. 20, No. Suppl.S2. pp. 48-51.
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title = "Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications",
abstract = "Objectives: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK). Setting and sample population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. Materials and Methods: Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression. Results: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. Conclusions: Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.",
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author = "A.R. Ness and A.K. Wills and O. Mahmoud and A. Hall and D. Sell and J. Smallridge and L. Southby and D. Stokes and S. Toms and A. Waylen and Y. Wren and J.R. Sandy",
note = "{\circledC} 2017 John Wiley & Sons A/S. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.",
year = "2017",
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Ness, AR, Wills, AK, Mahmoud, O, Hall, A, Sell, D, Smallridge, J, Southby, L, Stokes, D, Toms, S, Waylen, A, Wren, Y & Sandy, JR 2017, 'Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service: the Cleft Care UK study. Part 6: summary and implications', Orthodontics & craniofacial research, vol. 20, no. Suppl.S2, pp. 48-51. https://doi.org/10.1111/ocr.12188

Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service : the Cleft Care UK study. Part 6: summary and implications. / Ness, A.R.; Wills, A.K.; Mahmoud, O.; Hall, A.; Sell, D.; Smallridge, J.; Southby, L.; Stokes, D.; Toms, S.; Waylen, A.; Wren, Y.; Sandy, J.R.

In: Orthodontics & craniofacial research, Vol. 20, No. Suppl.S2, 01.06.2017, p. 48-51.

Research output: Contribution to journalSpecial issue

TY - JOUR

T1 - Centre-level variation in treatment and outcomes and predictors of outcomes in 5-year-old children with non-syndromic unilateral cleft lip treated within a centralized service

T2 - the Cleft Care UK study. Part 6: summary and implications

AU - Ness, A.R.

AU - Wills, A.K.

AU - Mahmoud, O.

AU - Hall, A.

AU - Sell, D.

AU - Smallridge, J.

AU - Southby, L.

AU - Stokes, D.

AU - Toms, S.

AU - Waylen, A.

AU - Wren, Y.

AU - Sandy, J.R.

N1 - © 2017 John Wiley & Sons A/S. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK). Setting and sample population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. Materials and Methods: Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression. Results: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. Conclusions: Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.

AB - Objectives: To summarize and discuss centre-level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care UK (CCUK). Setting and sample population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK and treated within a centralized service. Materials and Methods: Children had a range of treatment and outcome measures collected at a 5-year audit clinic. These outcomes included dento-alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self-confidence and strengths and difficulties from parental self-report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression. Results: There was centre-level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low. Conclusions: Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.

KW - centralization

KW - cleft lip

KW - cleft palate

KW - outcomes

KW - variation

UR - http://onlinelibrary.wiley.com/doi/10.1111/ocr.12188/abstract

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U2 - 10.1111/ocr.12188

DO - 10.1111/ocr.12188

M3 - Special issue

AN - SCOPUS:85021408959

VL - 20

SP - 48

EP - 51

IS - Suppl.S2

ER -