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

Abstract

Objective: 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. Design: Retrospective review and outcomes analysis (n = 739). Setting: Academic tertiary care center. Patients: 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). Interventions: Multidisciplinary care coordination program facilitated by the CNN. Main Outcome Measures: Patient age at first outpatient appointment and age at surgery, reported feeding issues, weight gain, and patient-cleft team communications. Results: After CNN implementation, median age at outpatient appointment decreased from 20 to 16 days ( P = .021), volume of patient-cleft team communications increased from 1.5 to 2.8 ( P < .001), and frequency of reported feeding concerns decreased (50% to 35%; P < .001). In the pre-CNN cohort, nonwhite and publicly insured patients experienced delays in first outpatient appointment ( P < .001), cleft lip repair ( P < .011), and cleft palate repair ( P < .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. Conclusions: 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.

Longitudinal Outpatient and School-Based Service Use among Children with Nonsyndromic Craniosynostosis

“…Craniofacial programs might also consider expanding staff to include "nurse navigators" to help coordinate longitudinal care, which have been shown to help improve outcomes and ameliorate disparities for children with craniofacial anomalies such as cleft lip or palate. 42 Inherent in this discussion is the importance of making such services both available and affordable to all families who need them. Previous literature on the overall costs of nonsyndromic craniosynostosis treatment is sparse, with available studies generally focusing only on the costs of hospitalization or during the time immediately following surgical care.…”

“…Craniofacial programs might also consider expanding staff to include “nurse navigators” to help coordinate longitudinal care, which have been shown to help improve outcomes and ameliorate disparities for children with craniofacial anomalies such as cleft lip or palate. 42…”

Socioeconomic Disparities in Cleft Lip Care

“…Outreach efforts targeting these populations for early and consistent clinical care could contribute to reducing these disparities. 23 Additionally, given the finding of this study that patients in underserved areas traveled significantly farther for cleft care, expanding options for virtual or local satellite office visits could reduce the burden in terms of time and transportation costs for families.…”

Surgical Care for Racial and Ethnic Minorities and Interventions to Address Inequities

“…In addition, comprehensive education sessions including classes led by social workers, transplant center, and financial coordinators was associated with higher completion of kidney transplant evaluation among African American patients 60 . Furthermore, patient navigation programs involving multidisciplinary teams for patients have been found to be associated with reduced time to treatment, including surgery, and treatment completion for breast cancer and cleft-palate 61,62 . Lastly, the use of decision aids have also been identified to help to reduce disparities in receipt of surgery.…”

“…60 Furthermore, patient navigation programs involving multidisciplinary teams for patients have been found to be associated with reduced time to treatment, including surgery, and treatment completion for breast cancer and cleft-palate. 61,62 Lastly, the use of decision aids have also been identified to help to reduce disparities in receipt of surgery. For example, the use of a videobased decision aid describing treatment options, surgical procedures, risks, benefits, and efficacy of total knee replacement was associated with improved receipt of total knee replacement among Black patients with osteoarthritis meeting clinical indications.…”