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A Cross-Sectional Analysis of the BC Children's Hospital Cleft Palate Program Waitlist
Leslie Tze Fung Leung1, Christine A Loock2, Rebecca Courtemanche1,3
1Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Patients on the Cleft Palate-Craniofacial Program (CPP) waitlist experience a median 11-month delay, missing crucial speech, orthodontic, and surgical assessments. Increased medical complexity and specialized speech needs significantly prolong wait times for these children.
Area of Science:
- Craniofacial Medicine
- Pediatric Healthcare Access
- Healthcare Management
Background:
- A previous review indicated suboptimal adherence to care recommendations at the BC Children's Hospital Cleft Palate-Craniofacial Program (CPP).
- Understanding wait times and assessment gaps for waitlisted patients is crucial for improving care delivery.
Purpose of the Study:
- To determine median wait times for patients on the CPP waitlist.
- To identify missed clinical assessments and their correlation with medical complexity, speech service needs, vulnerability, and distance.
- To inform strategies for optimizing patient access to care.
Main Methods:
- A cross-sectional study of 576 waitlisted patients at BC Children's Hospital Cleft Palate-Craniofacial Program.
- Analysis of additional wait time beyond recommended dates.
- Correlation of wait times with diagnosis, specialist requirements, speech needs, vulnerability, and travel distance.
- Assessment of missed plastic surgery, speech, and orthodontic evaluations against program and association guidelines.
Main Results:
- Median additional wait time was 11 months (IQR: 5-27 months).
- Longer waits were associated with craniofacial diagnosis (P=.019), need for speech services (P<.001), and multiple specialists (P<.001).
- Significant proportions of patients missed key assessments: 8% for plastic surgery, 62% for speech, and 21% for orthodontics.
Conclusions:
- Patients face substantial delays, averaging an additional year, impacting access to essential developmental assessments.
- Wait times are significantly influenced by clinical complexity and specialized service needs.
- Urgent allocation of additional resources is necessary to mitigate these delays and improve patient outcomes.
Objective:
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.
Design:
Cross-sectional.
Setting:
BC Children's Hospital Cleft Palate-Craniofacial Program.
Patients:
Five hundred seventy-six waitlisted patients.
Main Outcome Measures:
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.
Results:
Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis (P = .019), a need for formal speech assessments or evaluations (P < .001), or a requirement to see multiple specialists (P < .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.
Conclusion:
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.
