Exploring Delay to Follow-Up in a Rural Multidisciplinary Cleft Clinic

Area of Science:

• Craniofacial medicine
• Pediatric healthcare delivery
• Health services research

Background:

• Longitudinal, multidisciplinary care is essential for oral clefts.
• Delayed care for oral clefts can negatively impact patient outcomes.
• Loss to follow-up metrics do not capture patients who eventually return to care after significant delays.

Purpose of the Study:

• To explore and determine risk factors for delay to follow-up (DTFU) in a rural academic cleft clinic.
• To analyze the prevalence and characteristics of delayed follow-up visits in pediatric cleft care.
• To identify potential new metrics for assessing cleft care compliance.

Main Methods:

• Retrospective review of medical records from a multidisciplinary cleft clinic (2010-2019).
• Analysis of 282 patients and 953 visits to determine delay to follow-up (DTFU) in days.
• Statistical analysis to identify risk factors associated with DTFU, excluding driving distance, time, SES, cleft stage, and phenotype.

Main Results:

• 71% of patients experienced at least one follow-up delay of 30+ days; 50% had delays of 90+ days.
• The mean delay to follow-up was 73 days (approx. 2.5 months).
• Patients with missed appointments had a significantly higher risk of DTFU (P < 0.0001); patient-driven cancellations comprised over 50% of reasons.

Conclusions:

• Delay to follow-up is highly prevalent in this rural cleft clinic cohort.
• DTFU identifies patients with consistent delays, suggesting a need for targeted interventions to improve compliance.
• DTFU may serve as a valuable, implementable measure of cleft care compliance, warranting further research into its clinical outcome correlations.