Failure to Thrive After Implementation of a Cleft Nurse Navigator Program: A Reduction in Readmissions and...

ObjectiveTo evaluate the impact of implementation of a cleft nurse navigator (CNN) program on failure to thrive (FTT), readmission rates, and disparities among patients with cleft lip and/or palate (CL/P).DesignRetrospective cohort study comparing outcomes before and after CNN implementation.SettingTertiary pediatric craniofacial center with a multidisciplinary cleft care team.Patients, ParticipantsPatients with CL/P undergoing definitive cleft repair at a single institution from January 2010 to June 2024 (n = 992).InterventionsImplementation of a CNN program in 2016 focused on feeding support, care coordination, growth monitoring, and family outreach.Main Outcome Measure(s)Primary outcomes included rates of FTT, admission for FTT, and readmission for FTT. Secondary analyses evaluated racial and insurance-based disparities.ResultsOf 992 patients, 433 (43.6%) were pre-CNN and 559 (56.4%) post-CNN. FTT rates were similar (18.2% vs 16.8%, P = .556). Readmission for FTT was lower post-CNN (1.1% vs 4.6%, P < .001). Pre-CNN, readmission was higher among non-white than white patients (9.1% vs 2.4%, P = .002), equalizing post-CNN (1.4% vs 1.0%, P = .621). Insurance-based differences in readmission also decreased post-CNN. On multivariable regression, pre-CNN treatment (OR 5.0, 95% CI 1.9-13.1, P = .001), neonatal intensive care unit stay (OR 14.5, 4.2-50.1, P < .001), public insurance (OR 2.7, 1.1-6.6, P = .027), and non-white race (OR 2.5, 1.0-5.9, P = .044) independently predicted readmission.ConclusionsCNN implementation was associated with reduced readmissions for FTT and reduced racial and insurance-based disparities in readmission among patients with CL/P.