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Reduced Socioeconomic Disparities in Cleft Care After Implementing a Cleft Nurse Navigator Program.

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2021 Apr 07

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<p><strong>OBJECTIVE: </strong>To evaluate the impact of a Cleft Nurse Navigator (CNN) program on care for patients with cleft lip and cleft palate and assess the programs efficacy to reduce existing socioeconomic disparities in care.</p>

<p><strong>DESIGN: </strong>Retrospective review and outcomes analysis (n = 739).</p>

<p><strong>SETTING: </strong>Academic tertiary care center.</p>

<p><strong>PATIENTS: </strong>All patients presenting with cleft lip and/or cleft palate (CL/P) born between May 2009 and November 2019 with exclusions for atypical clefts, submucous cleft palates, international adoption, and very late presentation (after 250 days of life).</p>

<p><strong>INTERVENTIONS: </strong>Multidisciplinary care coordination program facilitated by the CNN.</p>

<p><strong>MAIN OUTCOME MEASURES: </strong>Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications.</p>

<p><strong>RESULTS: </strong>After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days ( = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 ( &lt; .001), and frequency of reported feeding concerns decreased (50% to 35%; &lt; .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment ( &lt; .001), cleft lip repair ( &lt; .011), and cleft palate repair ( &lt; .019) compared to white and privately insured patients, respectively. In the post-CNN cohort, there were no significant differences in first appointment timing by race nor surgical timing on the basis of racial identity nor insurance type.</p>

<p><strong>CONCLUSIONS: </strong>A variety of factors lead to delays in cleft care for marginalized patient populations. These findings suggest that a CNN can reduce disparities of access and communication and improve early feeding in at-risk cohorts.</p>



Alternate Title

Cleft Palate Craniofac J


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