Clinical Documentation Completeness in Orofacial Cleft Care Across High-Resource and Surgical Mission Settings: A Cross-Sectional Study
Document Type
Article
Publication Title
The Cleft Palate Craniofacial Journal
Abstract
Objective: To compare documentation completeness between preoperative records for children with orofacial cleft treated at a high-resource U.S. pediatric center and an itinerant surgical mission program.
Design: Cross-sectional analysis of a previously published, harmonized 2-cohort orofacial cleft dataset.
Setting: A U.S. tertiary pediatric craniofacial center (Children's Hospital of Philadelphia [CHOP]) and a CHOP-affiliated surgical mission program serving patients in Guatemala City.
Patients, Participants: All 817 preoperative records in the deposited dataset (684 CHOP, 2012-2019; 133 mission, 2017-2020); none were excluded. The deposit carries no patient identifier, and the source publication reports 514 CHOP and 115 mission patients, so records, not patients, are the unit of analysis.
Interventions: None (observational).
Main Outcome Measures: Documentation completeness of weight, syndromic status, comorbidity, family history, and prior-repair history, and a calculated per-record composite completeness score (0-1).
Results: Documentation was less complete in the mission cohort for every field, with risk differences for documentation completeness ranging from −0.29 (95% CI, −0.37 to −0.22) for family history to −0.80 (95% CI, −0.86 to −0.73) for weight (all P < .001). Mean composite completeness was 0.986 at CHOP versus 0.421 in the mission cohort (bootstrap mean difference, −0.56; 95% CI, −0.61 to −0.52). Gaps persisted after adjustment for age and cleft type.
Conclusions: Documentation completeness differed markedly by care setting within 1 shared instrument. The 5 affected fields are the only universally applicable history-dependent items in a 35-variable instrument; making them mandatory is a small change that would let mission cohorts support the same analyses as high-resource cohorts.
DOI
10.1177/10556656261488487
Publication Date
9-16-2026
Keywords
cleft lip and palate, data completeness, documentation, global surgery, health equity, surgical missions
ISSN
1545-1569
Recommended Citation
Nelson B, Haji-Boloori F, Kubiak A, Wu Z. Clinical Documentation Completeness in Orofacial Cleft Care Across High-Resource and Surgical Mission Settings: A Cross-Sectional Study. The Cleft Palate Craniofacial Journal. 2026; . doi: 10.1177/10556656261488487.
