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Exploring Delay to Follow Up in A Rural Multidisciplinary Cleft Clinic
Yasmeen M. Byrnes, MD 1; Stephanie P. Miller, BA 2; Katie Frank, MS 3; Jordan G. Law, BS 4; Joseph Dewalle, BS 3; Christian A. Kauffman, MD 1
1 Department of Plastic and Reconstructive Surgery, Geisinger Medical Center, Danville PA; 2 Geisinger Commonwealth School of Medicine, Scranton PA; 3 Department of Population Health Sciences, Geisinger Medical Center, Danville PA; 4 Phenomic Analytics & Clinical Data Core, Geisinger Medical Center, Danville PA

Background: Oral clefts require longitudinal multidisciplinary care with follow-up visits at regular intervals throughout a patientís childhood. Though loss to follow-up is commonly studied, this metric does not account for patients that do return to care, but months or years later than recommended. The aim of this study is to explore, and determine risk factors for, delays in cleft clinic follow-up visits at a rural academic center.
Methods: Medical records from the multidisciplinary cleft clinic at a single rurally-based institution between January 1, 2010 and December 31, 2019 were reviewed. The primary outcome was delay in follow-up, measured as the difference in days between recommended and actual follow-up dates for a given clinic visit. Socio-economic status (SES) was measured on a scale from 0-100 calculated from weighted Census data variables. Patient addresses were geocoded and driving distance (miles) and driving time (minutes) from cleft clinic was calculated.
Results: 282 patients were analyzed, with a total of 953 visits. 71% of patients experienced at least one delay in follow-up of 30 days or longer. 50% had at least one delay of 90 days or longer. Out of all visits, the mean delay in follow up was 73 days (around 2.5 months). 23% of patients experienced a delay of >90 days with at least half of their visits, while 11% experienced a delay of >90 days with every visit. Driving distance, driving time, and SES were not correlated with delay to follow up. Age at recommended follow-up date, a proxy for stage of cleft care, was also not correlated with delay. For canceled appointments, 50.5% of recorded cancellation reasons were patient-driven.
Conclusions: Delay to follow-up in multidisciplinary cleft clinic was prevalent in this rural cohort, with half of patients experiencing delays of 3 months or longer and about one in nine experiencing this delay with every visit. Distance from care, SES, and age at time of recommended follow-up were not predictors of delay. Delay to follow-up may be a new and valuable measure of cleft care compliance. It identifies patients with consistently high rates of delay in care, which could eventually lead to targeted interventions to increase compliance. Though timing of cleft care is known to be important in the context of a childís growth and development, further investigation is needed to determine the relationship between delay to follow-up and clinical outcomes in cleft patients.


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