Achieving and Sustaining Standardized Measurement of Treatment Outcomes in Children With Cleft Lip/Palate: Pilot Study of a Multifaced Implementation Strategy.

Abstract

ObjectivePrior work has identified numerous barriers to standardized outcome measurement in cleft care. The objective of this study was to evaluate a multifaceted implementation strategy to collect standardized outcomes for children with cleft lip and/or palate (CL/P).DesignA one-armed, single-site pilot study of a multifaceted implementation strategy.SettingA metropolitan children's hospital.PatientsFive-year-old children with CL/P.InterventionsA multifaceted implementation strategy for standardized outcome measurement.Main Outcomes MeasuresThe primary outcome measure was penetration of the intervention, defined as the proportion of children for whom the standardized measures of aesthetic, dental, and speech outcomes were collected. Penetration pre-implementation and 12 months post-implementation were compared. The secondary outcome was acceptability of standardized outcome measurement among providers and staff, evaluated with the Acceptability of Intervention Measure.ResultsThe implementation strategy resulted in high penetration of standardized outcome measurement: measurement of aesthetic outcomes increased from 7% to 82% (p < .0001); measurement of dental outcomes increased from 0% to 56% (p < .0001); measurement of speech outcomes increased from 29% to 77% (p = .0001). Acceptability of standardized outcome measurement was high, with 93% of cleft team providers and staff (n = 14/15) reporting that they somewhat or completely agreed that standardized outcome measurement met their approval, was appealing, was welcomed, and was liked. Penetration continued to improve after the implementation period, with high rates of outcome measure collection sustained for four years following implementation.ConclusionsDeployment of a multifaceted implementation strategy led to substantial increases in the collection of aesthetic, dental, and speech outcomes among children with CL/P.