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CSAG II Research into the impact of the reorganisation of cleft services (NIHR) Jonathan Sandy.
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Transcript of CSAG II Research into the impact of the reorganisation of cleft services (NIHR) Jonathan Sandy.
CSAG II
Research into the impact of the
reorganisation of cleft services (NIHR)
Jonathan Sandy
CSAG I – why did it happen?
Jonathan Sandy
Royal Colleges
Department of Health
Clinician Groups
Parent and Patient Groups
Evidence – not much but Eurocleft –Comparison of 6 European Centers
B E A F C D
1 OOO
OOOOOO OOO
O
O
OOOOOOO OOOOOO
OO
OOOOO O
O
OOO OOO
2 OOOOOO
OO OOO
O OOO
O OO
OOO OO O
OOOO OOO
O OOOOOO
OOOO
OO OO O
O OO
OOO
OO O O
OOOO
3 O OOO O O
OO
4 O O O
OO O
O
O
OOO
OOOO
OOOO
OO OOOO
O
5 O O
O
O
O
O OO OO
6
Data published in 1991
The Clinical Standards Advisory Group Cleft Lip and Palate
Process data
Outcomes
Patient and Parent views
CSAG Twelve Year Olds
Mean ANB Range
17% 2.9 2° 4°
13% 5.6 4° 8°
70% -2.4 -13 +2°
I
II
III
Data is prior to 1998
Alveolar Bone Grafting
Successful 58% 97%
Seriously deficient
30%
Failed 12% 3%
Oslo
n=157
CSAG
UK CSAG
5 year olds 12 year olds
1 O O
2 OOOOO OOOOOO
3 OOOOOOO OOOOO
4 OOOO OOOOO
5 OOOO OOO
Data is prior to 1998
Intelligibility 5 year olds 12 year
olds
Normal 19% 47%
Different 30% 34%
Provokes Comment 32%
15%
Unintelligible 19% 4%
Speech
Patient and Parent Satisfaction
Published in 1998
CSAG
Compelling evidence from a detailed and meticulous study
Recommendations unanimous
Recommendations accepted by Government
Recommendations consistent with centres from abroad
Recommendations
57 cleft units to be concentrated in 8-15 centres
0
10
20
30
40
50
60
Group 1 & 2 Group 3 Group 4 & 5
Per
cen
tag
eAudit from 3 Regions
Data from 2003
0% 20% 40% 60% 80% 100%
3 Regions
CSAG
Oslo
GOS
% GOSLON and Five Year Index
Group 1 & 2
Group 3
Group 4 & 5
Audit from 3 Regions
Data from 2003
Mike Wake Annals of The Royal College of Surgeons
Increased volume
=
Improved Outcomes
Research Strategy
CFSGBI – Research and Audit Leads
Workshop in RCTs – March 2005
Funding opportunities – Healing Foundation
Research leads
Andy Ness SteveThomasLifecourse Determinants Nutrition and
Cancer
The Research Team
Sam Leary Charlotte Atkinson Andrea Waylen Alex Griffiths Martin PerssonStatistics Nutrition Psychology Statistics Project manager
More posts with NIHR programme…
NIHR programme
Workshops and strategy
Systematic reviews
Care and outcomes for cleft children
CSAG-II
Concentrate on 5 year olds for outcomes
Speech, hearing, oral health, dento – alveolar relations etc
Parental and team questionnaires
Process and infrastructure
Funding
Bill Shaw $6 million NIH
Andy Ness £3 million NIHR
Healing Foundation £2 million
MCRN support costs – Sally Davies