Interdisciplinary Craniofacial Teams

Austin et al. (2010) reported on a the results of a descriptive study in which the mothers of 253 (of 519 eligible) children (age 2-7 years) in three states, with cleft lip (CL), cleft palate (CP), or cleft lip and cleft palate (CLP) were interviewed by phone regarding the type and quality of care their children received.  The authors sought to determine if the care mirrored that recommended by the American Cleft Palate–Craniofacial Association (ACPA):  interdisciplinary teams of specialists  making appropriate referrals for audiological and otolaryngologic care, surgical intervention, dental care, speech-language pathology services, genetic evaluations and counseling, psychological and social services, nursing care, and pediatric care (American Cleft Palate-Craniofacial Association, 2009).  Specifically, the goal was to determine whether or not children with orofacial clefts received better (more comprehensive) care and whether or not their mothers perceived it as better when it was provided by an interdisciplinary team, rather than individual providers.

Mothers were asked whether or not their child was receiving interdisciplinary care, which was defined as, “an organized cleft care team made up of at least a surgeon, a dental professional, and a speech professional” (Austin et al., 2010, p. 3).  The telephone interview that mothers participated in covered questions regarding education and advice parents received at diagnosis, surgeries, speech therapy, hearing tests, dental care, genetic consultation, psychological/social services, primary care, health conditions, and overall health and functional health status of the child.  

Children's characteristics such as gender, state of residence, mother’s age at time of interview, maternal race/ethnicity/educational attainment, household income, and insurance type did not significantly vary between those receiving team care and individual care.  However, nearly half receiving team care had CLP, while only one quarter of those receiving individualized care did.

Children receiving team care had more surgeries, were more likely to receive more noncleft-related medical care in the previous year, hearing testing in the previous year, dental care, and genetic counseling since the diagnosis of their cleft.  Mothers of children without team care were more than twice as likely to rate their child’s cleft care as poor.  Despite these differences, mothers of children without team care however were no more likely to perceive their child’s overall health outcomes as poor.  These results suggest that children with cleft palate do receive more comprehensive care when treated by an interdisciplinary team, as recommended by ACPA, and that they are more satisfied with the care  However, overall outcomes are not perceived by their mothers any differently than the care/outcomes of children receiving individualized care.  The authors note that parent perceptions may not be the most accurate measure of medical outcome and alternative, possibly quantitative measures, might be preferable.  Furthermore note that the mothers who chose to participate in the study were more likely to have education beyond high school and the non-Hispanic white, possibly confounding the results.  Another possible limitation of the study was that a child was only considered to have team care if they were currently working with a team, however since children in the study varied in age from 2 to 7 years, it is possible that they were treated by such a team in the past.

Despite these limitations, the authors note that two of their knowledge, “the current study is the first to allow a comprehensive examination of services and treatments received by children with orofacial clefts, both overall, and stratified by team care status” (Austin et al., 2010, p. 7)  Further research with improved outcome measures and less confounding factors is needed.

References

American Cleft Palate-Craniofacial Association. (2009). Parameters for evaluation and treatment of patients 

     with cleft lip/palate or other craniofacial anomalies, (November). Retrieved from http://dspace.iss.it

     /srdspace/handle/2198/442.

Austin, A.A., Druschel, M.C.., Romitti, P.A., West, I.I., Damiano, P.C., Burnett, W. (2010). 

     Interdisciplinary craniofacial teams compared with individual providers: Is orofacial cleft care more 

      comprehensive and do parents perceive better outcomes? The Cleft Palate-Craniofacial Journal: 

     Official Publication of the American Cleft Palate-Craniofacial Association, 47(1), 1-8. doi:  

     10.1597/08-250.1.