Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina.
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2020-11
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Abstract
Objective
To characterize operative care for cleft lip and/or palate (CL/P) based on location (ie, from American Cleft Palate Craniofacial Association [ACPA]-approved multidisciplinary teams or from community providers).Design
Cross-sectional analysis of Healthcare Cost and Utilization Project State Inpatient Database and State Ambulatory Surgery & Services Database databases for North Carolina from 2012 to 2015.Setting/patients and main outcome measures
Clinical encounters for children with CL/P undergoing operative procedures were identified, classified by location as "Team" versus "Community," and characterized by demographic, geographic, clinical, and procedural factors. A secondary evaluation reviewed concordance of team and community practices with an ACPA guideline related to coordination of care.Results
Three teams and 39 community providers performed a total of 3010 cleft-related procedures across 2070 encounters. Teams performed 69.7% of total volume and performed the majority of cleft procedures, including cleft lip repair, palate repair, alveolar bone grafting, and correction of velopharyngeal insufficiency. Community locations principally offered myringotomy and rhinoplasty. Team care was associated with higher guideline concordance.Conclusions
American Cleft Palate Craniofacial Association -approved team-based care accounts for the majority of cleft-related care in North Carolina; however, a substantial volume of cleft-related procedures was provided by community providers, with 3 providers accounting for the vast majority of community cases.Type
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Le, Elliot, Peter Shrader, Hayden Bosworth, Jillian Hurst, Benjamin Goldstein, Amelia Drake, Jeyhan Wood, Lisa R David, et al. (2020). Provision and Utilization of Team- and Community-Based Operative Care for Patients With Cleft Lip/Palate in North Carolina. The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association, 57(11). pp. 1298–1307. 10.1177/1055665620946565 Retrieved from https://hdl.handle.net/10161/29646.
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Scholars@Duke
Jillian Hurst
Intersections of the upper respiratory microbiome, environmental exposures, and childhood respiratory infections
Early life exposure to and colonization with microbes has a profound influence on the education of the immune system and susceptibility to viral and bacterial infections later in life. My research is focused on the influence of the upper respiratory microbiome on the development of recurrent respiratory infections, including acute otitis media (AOM), the leading cause of antibiotic prescriptions and healthcare consultations among children. Importantly, some children develop recurrent infections that are thought to be linked to dysbiosis of the nasopharyngeal microbiome. My overarching goals are to identify alterations in the upper respiratory microbiome associated with AOM and to elucidate host factors and exposures that predispose some children to the development of recurrent AOM episodes.
Children's Health & Discovery Initiative:
The prenatal period, infancy, childhood, and adolescence, represent critical time periods of human development that include more developmental milestones than any other period of the lifespan. Conditions during these developmental windows – including biological, social, economic, health, and environmental factors – have a profound impact on lifelong health. The Children’s Health and Discovery Initiative (CHDI) was founded on the hypothesis that interventions early in life will improve population health across the lifespan. To this end, the overarching goal of the CHDI is to create a robust coalition of multidisciplinary investigators and a pipeline of infrastructure, data, and research projects focused on developing innovative approaches to identifying and modulating early life factors that impact lifelong health and well-being.
Benjamin Alan Goldstein
I study the meaningful use of Electronic Health Records data. My research interests sit at the intersection of biostatistics, biomedical informatics, machine learning and epidemiology. I collaborate with researchers both locally at Duke as well as nationally. I am interested in speaking with any students, methodologistis or collaborators interested in EHR data.
Please find more information at: https://sites.duke.edu/bgoldstein/
Joao Ricardo Nickenig Vissoci
Joao Ricardo Nickenig Vissoci, MSc, PhD is an Associate Professor of Emergency Medicine, Neurosurgery, Global Health and Biostatistics and Bioinformatics. He is the Chief of the Division of Translational Health Sciences in the Department of Emergency Medicine, co-Director of the Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center and the Associate Director for Education of the Research Design and Analysis Core (RDAC), Duke Global Health Institute. Dr. Vissoci has a background in social psychology and data science. Dr. Vissoci, a Brazilian native, earned a bachelor’s degree in Psychology from State University of Maringá/Brazil, a Masters in Physical Education, an MBA in Human Resources, and a PhD in Social Psychology. During his PhD, he completed a fellowship in Data Science at Duke University. After graduating his PhD in Social Psychology from the Pontificia Universidade Católica of São Paulo/Brazil, Dr. Vissoci completed a postdoctoral fellowship at the University of Sao Paulo (2015) in Design and Analysis for Mental Health research. He completed a second postdoctoral fellowship at the Duke Global Health Institute in Global Health and Data Science in 2016. Dr. Vissoci held a faculty position and taught Public Health and Health Sciences in Brazil from 2009 to 2015. After completing his fellowship at DGHI, he joined the Duke Department of Emergency Medicine as faculty in 2017. In his last 14 years as faculty (2009-current), he has mentored over 200 trainees at all levels of training from undergraduate, graduate, medical education, postdoctoral to faculty level. He has published over 200 manuscripts and collaborated on over 6 R-level NIH grants, multiple (K and D) NIH training grants, other federal grants UK/Brazil based, and foundational grants.
His research interests focus on leveraging data through analytics and technology to bridge the gap in access and equity in care in low resource settings, translating evidence into practice or policy impact. He uses data science and mixed-methods research to design and implement innovative data-driven solutions to address health care gaps.
Alexander C Allori
Pediatric plastic and craniofacial surgeon, taking care of children with cleft lip/palate and other facial differences.
Dedicated to the improvement of multidisciplinary team-based care, especially by way of standardized, prospective outcomes measurement ("If you don't measure it, you can't improve it.")
Passionate about causal inference for real-world data (RWD) in observational studies.
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