title: Improving patient follow-up in developing regions.
abstract: BACKGROUND
  Cleft surgery follow-up in developing regions is challenging. This study evaluated rates, costs, and satisfaction of 2 follow-up programs at the Guwahati Comprehensive Cleft Care Centre (GC4) in Assam, India.
  
  
  METHODS
  For this study, 10,582 postoperative visits were analyzed from May 2011 to November 2013. A questionnaire was administered to subsets of follow-up patients at both locations. Costs were calculated.
  
  
  RESULTS
  Eighty-five percent of patients had follow-up at GC4, and 15% were seen in the patients' local districts. One hundred ninety-five questionnaires were completed (122 at GC4, 73 in local districts). Patients with local follow-up had fewer accompanying family members (mean, 1.95 vs 0.99; P = 0.00), fewer days off work (mean, 1.84 vs 1.15; P = 0.19), less lost income (Indian rupees 367 vs 143, P = 0.00), and lower direct costs (mean Rs, 911 vs 299; P = 0.00). The financial burden of local follow-up was significantly lower (P = 0.003). No significant differences were seen for convenience, likelihood of attending follow-up, or satisfaction. Follow-ups increased after revising programs from a mean of 139 monthly visits (follow-up to surgery ratio of 0.722) to a mean of 363 visits (ratio of 1.57). The center's mean cost for local follow-up was Rs 303 per patient, whereas the estimated costs would have been Rs 1100 for follow-up at the center.
  
  
  CONCLUSIONS
  This study demonstrates potential improvements in costs and outcomes by changing the model of care. Despite significant follow-up challenges, much progress can be achieved through process changes and outreach follow-up programs. The results have important applications across the developing world.
authors.affiliation: From the *Plastic Surgery, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada; †Operation Smile India, Mahendra Mohan Choudhury Hospital, Panbazar, Guwahati, India; and ‡Operation Smile, Virginia Beach, Virginia.
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Jansen
authors.forename: Leonardo
authors.initials: L
authors.lastname: Carillo
authors.forename: Lisa
authors.initials: L
authors.lastname: Wendby
authors.forename: Hannah
authors.initials: H
authors.lastname: Dobie
authors.forename: Jonashree
authors.initials: J
authors.lastname: Das
authors.forename: Carolina
authors.initials: C
authors.lastname: Restrepo
authors.forename: Alex
authors.initials: A
authors.lastname: Campbell
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000359:Aftercare / Q000191:economics / Q000523:psychology; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D003906:Developing Countries; D004180:Direct Service Costs; D005190:Family; D005382:Financing, Personal; D005500:Follow-Up Studies; D015285:Hospital-Patient Relations; D006801:Humans; D007182:Income; D007194:India; D007223:Infant; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires; D014195:Travel