title: Telemedicine in Cleft Care: Reliability and Predictability in Regional and International Practice Settings.
abstract: BACKGROUND
  Regional and international cleft care providers are challenged in their ability to deliver reliable, comprehensive care. Our institution utilizes video teleconferencing to facilitate initial evaluation and postoperative cleft care. This study describes our experience using telemedicine, generates a perioperative treatment algorithm using this technology, and compares cost-utility of telemedicine to in-person ambulatory visits when regional practices are involved.
  
  
  METHODS
  A 5-year retrospective review of all cleft patients evaluated in an ambulatory setting was conducted. Patient demographics and location, number, and type of telemedicine visits were recorded. Specific treatment algorithms utilizing telemedicine for perioperative care for primary and secondary cleft lip and nasal repair, palatoplasty, and operation for velopharyngeal insufficiency are described. A cost-utility analysis was performed comparing distances between patient homes and primary hub versus telemedicine clinic sites.
  
  
  RESULTS
  Five hundred nineteen patients were identified; 18.1% attended at least 1 teleconferencing visit. Postoperative follow-up was 100%. The majority of screening, preoperative, and postoperative care was provided using telemedicine. In-person evaluations were performed when intraoral assessments were necessary. Telemedicine visits were associated with an average savings of 239 miles per visit in the United States and 578 miles per visit in Mexico.
  
  
  CONCLUSIONS
  Video teleconferencing can be used to provide comprehensive regional and international cleft care to facilitate initial evaluations and consistent follow-up. This technology can alleviate the travel burden on families and cleft care providers practicing over a large geographic radius.
authors.affiliation: Division of Plastic Surgery, Shriners Hospital for Children, Los Angeles, California.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Costa
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Yao
authors.forename: T Justin
authors.initials: TJ
authors.lastname: Gillenwater
authors.forename: Goretti Ho
authors.initials: GH
authors.lastname: Taghva
authors.forename: Sarah
authors.initials: S
authors.lastname: Abrishami
authors.forename: Terri A
authors.initials: TA
authors.lastname: Green
authors.forename: William P
authors.initials: WP
authors.lastname: Magee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000628:therapy*; D002972:Cleft Palate / Q000628:therapy*; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008800:Mexico; D012017:Referral and Consultation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017216:Telemedicine / Q000191:economics / Q000379:methods*; D014481:United States