Medical Complexity and Health Care Utilization Among Pediatric Patients With Isolated Cleft Palate

A cleft palate is a common birth defect that can occur in isolation or in combination with other congenital anomalies. Children with medical complexity (CMC) represent a subgroup of patients with increased health care needs. This study aimed to investigate the association with cleft palate and CMC to guide early screening and treatment plan.

A retrospective review of the Pediatric Health Information System (PHIS) database was conducted from 2015 to 2023 for inpatient encounters of patients with cleft palate. Patient demographics, associated anomalies, complex chronic conditions (CCCs), and surgical outcomes were extracted and analyzed. Statistical analyses were performed to compare categorical and continuous variables between CMC and non-CMC.

A total of 2313 pediatric patients with cleft palate were identified, with 318 CMC (13.7%) and 1995 non-CMC (86.3%). CMC were more likely to have public insurance (P=0.005), resided in a low overall child opportunity level (COI) neighborhood (P=0.024), and had a higher cost of hospitalization and longer length of stay (P<0.001). They also had a higher proportion of all CCCs and syndromic cleft palate and were more likely to have associated ear anomaly, comorbid conditions, surgical complications, and all-cause readmissions.

This study demonstrated that medical complexity in patients with cleft palate is associated with higher health care utilization and worse clinical outcomes. These findings emphasize the need for early recognition and involvement of multidisciplinary care across multiple domains to support a patient-specific intervention that may improve resource allocation and long-term clinical outcomes.