title: Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part III: impact and sustainability.
abstract: BACKGROUND
  The Guwahati Comprehensive Cleft Care Center (GCCCC) utilizes a high-volume, subspecialized institution to provide safe, quality, and comprehensive and cost-effective surgical care to a highly vulnerable patient population.
  
  
  METHODS
  The GCCCC utilized a diagonal model of surgical care delivery, with vertical inputs of mission-based care transitioning to investments in infrastructure and human capital to create a sustainable, local care delivery system. Over the first 2.5 years of service (May 2011-November 2013), the GCCCC made significant advances in numerous areas. Progress was meticulously documented to evaluate performance and provide transparency to stakeholders including donors, government officials, medical oversight bodies, employees, and patients.
  
  
  RESULTS
  During this time period, the GCCCC provided free operations to 7,034 patients, with improved safety, outcomes, and multidisciplinary services while dramatically decreasing costs and increasing investments in the local community. The center has become a regional referral cleft center, and governments of surrounding states have contracted the GCCCC to provide care for their citizens with cleft lip and cleft palate. Additional regional and global impact is anticipated through continued investments into education and training, comprehensive services, and research and outcomes.
  
  
  CONCLUSIONS
  The success of this public private partnership demonstrates the value of this model of surgical care in the developing world, and offers a blueprint for reproduction. The GCCCC experience has been consistent with previous studies demonstrating a positive volume-outcomes relationship, and provides evidence for the value of the specialty hospital model for surgical delivery in the developing world.
authors.affiliation: *From the Operation Smile, Virginia Beach, Virginia; †Penn State Hershey Medical Center, Hershey, Pennsylvania; ‡Cedars Sinai Medical Center, Los Angeles, California; and §Operation Smile India, Guwahati Comprehensive Cleft Care Center, Guwahati, India.
authors.forename: Alex
authors.initials: A
authors.lastname: Campbell
authors.forename: Carolina
authors.initials: C
authors.lastname: Restrepo
authors.forename: Don
authors.initials: D
authors.lastname: Mackay
authors.forename: Randy
authors.initials: R
authors.lastname: Sherman
authors.forename: Ajit
authors.initials: A
authors.lastname: Varma
authors.forename: Ruben
authors.initials: R
authors.lastname: Ayala
authors.forename: Hiteswar
authors.initials: H
authors.lastname: Sarma
authors.forename: Gaurav
authors.initials: G
authors.lastname: Deshpande
authors.forename: William
authors.initials: W
authors.lastname: Magee
mesh_terms: D000359:Aftercare; D002971:Cleft Lip / Q000601:surgery; D002972:Cleft Palate / Q000601:surgery; D003159:Community-Institutional Relations; D003191:Comprehensive Health Care; D003363:Cost Control; D003362:Cost-Benefit Analysis; D019465:Craniofacial Abnormalities / Q000191:economics / Q000601:surgery*; D019033:Delivery of Health Care, Integrated; D003906:Developing Countries; D006782:Hospitals, Special; D006784:Hospitals, Teaching; D006801:Humans; D007194:India; D007449:Investments; D007857:Leadership; D009738:Nursing Service, Hospital; D015596:Nutrition Assessment; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D061214:Patient Safety; D018579:Patient Selection; D018802:Patient-Centered Care; D015397:Program Evaluation; D055818:Public-Private Sector Partnerships; D011787:Quality of Health Care / Q000592:standards*; D019651:Plastic Surgery Procedures / Q000191:economics* / Q000592:standards