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.
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CSAG II
Research into the impact of the
reorganisation of cleft services (NIHR)
Jonathan Sandy
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CSAG I – why did it happen?
Jonathan Sandy
Royal Colleges
Department of Health
Clinician Groups
Parent and Patient Groups
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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
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The Clinical Standards Advisory Group Cleft Lip and Palate
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Process data
Outcomes
Patient and Parent views
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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
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Alveolar Bone Grafting
Successful 58% 97%
Seriously deficient
30%
Failed 12% 3%
Oslo
n=157
CSAG
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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
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Intelligibility 5 year olds 12 year
olds
Normal 19% 47%
Different 30% 34%
Provokes Comment 32%
15%
Unintelligible 19% 4%
Speech
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Patient and Parent Satisfaction
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Published in 1998
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CSAG
Compelling evidence from a detailed and meticulous study
Recommendations unanimous
Recommendations accepted by Government
Recommendations consistent with centres from abroad
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Recommendations
57 cleft units to be concentrated in 8-15 centres
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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
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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
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Mike Wake Annals of The Royal College of Surgeons
Increased volume
=
Improved Outcomes
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Research Strategy
CFSGBI – Research and Audit Leads
Workshop in RCTs – March 2005
Funding opportunities – Healing Foundation
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Research leads
Andy Ness SteveThomasLifecourse Determinants Nutrition and
Cancer
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The Research Team
Sam Leary Charlotte Atkinson Andrea Waylen Alex Griffiths Martin PerssonStatistics Nutrition Psychology Statistics Project manager
More posts with NIHR programme…
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NIHR programme
Workshops and strategy
Systematic reviews
Care and outcomes for cleft children
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CSAG-II
Concentrate on 5 year olds for outcomes
Speech, hearing, oral health, dento – alveolar relations etc
Parental and team questionnaires
Process and infrastructure
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Funding
Bill Shaw $6 million NIH
Andy Ness £3 million NIHR
Healing Foundation £2 million
MCRN support costs – Sally Davies
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