Improving Education and Standards for Cleft Care in the Developing World: The Partner Hospital Model
Chad A. Purnell, MD1, Jennifer L. McGrath, MD1, Arun K. Gosain, MD2.
1Northwestern Feinberg School of Medicine, Chicago, IL, USA, 2Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
PURPOSE: The partner hospital model identifies hospitals in the developing world to educate and enable local surgeons to deliver effective cleft care. This study aimed to determine the outcome of the partner hospital model.
METHODS: Twelve partner hospitals that had been sponsored by Smile Train for 5 years or more, distributed over four continents, were selected. Activities were evaluated based on cleft surgical data, and from surveys completed by hospital personnel.
RESULTS: A mean of 82% of cleft patients at partner hospitals had sponsored surgeries. After partnership, all hospitals implemented pre-operative checklists for cleft surgery, and 5 implemented checklists for all surgeries. All hospitals had personnel who received safety training as a result of partnership. There was no change in 30-day reoperations or readmissions. Follow-up rate increased by 20% (p=0.03). Facilities recruited 1.8 additional cleft surgeons (p<0.01) and increased the number of cleft surgical trainees by a mean of 13.3 annually (p=0.11). 2.5±1.7 additional ancillary services were added, resulting in 75% of partner hospitals having a basic multidisciplinary cleft team (Surgery, Speech, and Dental), compared to 25% prior to partnership (p<0.01). Total cleft surgeries, alveolar bone grafts, and percentage of revision surgeries increased significantly as length of partnership progressed (p<0.04).
CONCLUSIONS: A model to enhance global education and delivery of cleft care through development and support of local partner hospitals increases the amount and quality of cleft care delivered at participating hospitals. Safety initiatives for cleft care demonstrate effects extending to global surgical care delivered at partner hospitals.
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