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