Geospatial Analysis of Risk Factors Contributing to Loss to Follow-up in Cleft Lip/Palate Care.

BACKGROUND

Multidisciplinary cleft care depends on follow-up at specified time points to monitor and address functional or aesthetic concerns that may arise during a child's development. However, loss to follow-up (LTFU) is common and can lead to missed opportunities for therapeutic and surgical intervention. This study explores clinical, demographic, and geographic determinants of LTFU in cleft care.

METHODS

Medical records were retrospectively evaluated for 558 pediatric patients of a single mid-volume cleft team. The primary outcome was LTFU. Spatial dependency was evaluated using variograms. The probability of LTFU was assessed using a generalized linear geostatistical model within a Bayesian framework. Risk maps were plotted to identify vulnerable communities within our state at higher risk of LTFU.

RESULTS

Younger age at last encounter was a strong predictor of LTFU (P < 0.0001), even when ignoring spatial dependency among observations. When accounting for spatial dependency, lower socioeconomic status [OR = 0.98; 95% CI = (0.97-0.99)] and cleft phenotype [OR = 0.55; 95% CI = (0.36, 0.81)] were significant predictors of LTFU. Distance from the cleft team and rural/urban designation were not statistically significant predictors. Cartographic representation of predicted probability of LTFU revealed vulnerable communities across our state, including in the immediate vicinity of our cleft center.

CONCLUSIONS

Geostatistical methods are able to identify risk factors missed by traditional statistical analysis. Knowledge of vulnerable populations allow a cleft team to allocate more resources toward high-risk areas to rectify or prevent deficiencies in care.