Improvement in total and face-to-face provider time in a multidisciplinary craniofacial anomalies team clinic: An interventional study

Authors: WOOD, ALEXIS - Children'S Nutrition Research Center (CNRC); GARCIA DE MITCHELL, C - Baylor College Of Medicine; KAUSHIK, RUCHI - Baylor College Of Medicine

Submitted to: Cleft Palate-Craniofacial Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/6/2021
Publication Date: 6/24/2021
Citation: Wood, A.C., Garcia de Mitchell, C.A., Kaushik, R. 2021. Improvement in total and face-to-face provider time in a multidisciplinary craniofacial anomalies team clinic: An interventional study. Cleft Palate-Craniofacial Journal. https://doi.org/10.1177/10556656211021705.
DOI: https://doi.org/10.1177/10556656211021705

Interpretive Summary: Individuals with obesity are at risk of sleep apnea which, in turn, dramatically increases their risk for a host of negative outcomes including cardiovascular diseases (CVDs) and early mortality. One factor which increases the risk of sleep apnea in individuals with obesity is the presence of craniofacial abnormalities. However, this does not need to be the case; Multidisciplinary Craniofacial Team Clinics (MDCTs) have been implemented which diagnose and treat the multiple health sequelae associated with craniofacial abnormalities, including obesity-related problems such as sleep apnea. However, attendance at MDCTs is low, particularly when the patient is a child. A major cause of low attendance is the amount of time spent waiting at these clinics: while an advantage is that patients and their families can see a variety of medical health specialists (dieticians, psychologists, pediatricians and sleep specialists), a problem is that a lot of time can be spent between providers which is frustrating for children and their families. This study sought to investigate which factors influenced time spent without a provider, and the effect of an intervention designed to reduce time spent without a provider at an MDCT for young children. The study found that approximately 65% of overall clinic time was spent without a provider in the room. The observational data showed that the amount of the visit spent waiting to see a provider increased as more health care providers were seen during the visit. When the intervention scheduled patients who needed fewer provider encounters to a specialty clinic, there was a reduction both in the absolute amount of time spent without a provider, and in the percentage of the overall clinic visit spent without a provider. Children with craniofacial abnormalities and with overweight/obesity need to see additional providers compared to those without obesity. The results of the current study suggest that these children may be best served by being scheduled for multiple visits at specialty clinics, rather than one, long visit at a multidisciplinary clinics.

Technical Abstract: The objective of our study was to identify factors contributing to time a family spends in a Multidisciplinary Craniofacial Team Clinic (MDCT) and implement an intervention to reduce this time. One hundred sixty-seven patients with craniofacial diagnoses participated in the study in an American Cleft Palate-Craniofacial Association-accredited MDCT in an academic children's hospital. An interventional study design used a restructuring of clinics to serve those patients requiring fewer provider encounters separately. Time data were tabulated over approximately 2 years. Following 9 months of data collection, patients requiring fewer provider encounters were scheduled to a separate clinic serving children with craniosynostosis, and data were collected in the same fashion for another 14 months. Principal outcome measures included total visit time and proportion of the visit spent without a provider in the room before and after clinic restructuring. The average time spent by family in a clinic session was 161.53 minutes, of which 64.3% was spent without a provider in the room. Prior to clinic restructuring, a greater number of provider encounters was inversely associated with percentage of time spent without a provider (P<.001). Upon identifying this predictor, scheduling patients who needed fewer provider encounters to a Craniosynostosis Clinic session resulted in reduction in absolute and percentage of time spent without a provider (P<.001). The number of provider encounters is a significant predictor of the proportion of a clinic visit spent without a provider. Clinic restructuring to remove patient visits that comprise fewer provider encounters resulted in a greater percentage of time spent with a provider in an MDCT.