title: Centralization of cleft care in the UK. Part 6: a tale of two studies.
abstract: OBJECTIVE
  We summarize and critique the methodology and outcomes from a substantial study which has investigated the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after the UK government started to implement the centralization of cleft care in response to an earlier survey in 1998, the Clinical Standards Advisory Group (CSAG).
  
  
  METHODS
  A UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Data were collected from children born in the UK with a unilateral cleft lip and palate between 1 April 2005 and 31 March 2007.
  
  
  METHODS
  We discuss and contextualize the outcomes from speech recordings, hearing, photographs, models, oral health and psychosocial factors in the current study. We refer to the earlier survey and other relevant studies.
  
  
  RESULTS
  We present arguments for centralization of cleft care in healthcare systems, and we evidence this with improvements seen over a period of 15 years in the UK. We also make recommendations on how future audit and research may configure.
  
  
  CONCLUSIONS
  Outcomes for children with a unilateral cleft lip and palate have improved after the introduction of a centralized multidisciplinary service, and other countries may benefit from this model. Predictors of early outcomes are still needed, and repeated cross-sectional studies, larger longitudinal studies and adequately powered trials are required to create a research-led evidence-based (centralized) service.
authors.affiliation: National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK.|School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: A K
authors.initials: AK
authors.lastname: Wills
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: A
authors.initials: A
authors.lastname: Waylen
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Al-Ghatam
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.|Musgrove Park Hospital, Taunton, UK.
authors.forename: T E M
authors.initials: TE
authors.lastname: Jones
authors.affiliation: Cleft Lip and Palate Association, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Preston
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Ireland
authors.affiliation: Centre for Appearance Research, University of the West of England, Bristol, UK.
authors.forename: M
authors.initials: M
authors.lastname: Persson
authors.affiliation: South Thames' Cleft Unit, Guy's and St Thomas Hospital, London, UK.|Cleft Net East Cleft Network, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: J
authors.initials: J
authors.lastname: Smallridge
authors.affiliation: Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.|Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Hall
authors.affiliation: Speech and Language Therapy Department and Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital NHS Foundation Trust, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Sell
authors.affiliation: School of Oral and Dental Sciences, University of Bristol, Bristol, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Sandy
mesh_terms: D002675:Child, Preschool; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D008297:Male; D013060:Speech; D006113:United Kingdom
keywords: Cleft Lip; Cleft Palate; Cross-Sectional Studies