The NHS Five Year Forward View promoted seeing patients closer to home in order to provide better care, cut down on missed appointments and reduce costs. This encouraged the development of ‘hub and spoke’ models of care, but this model has rarely been implemented for paediatric cochlear implantation in the UK. Our Editors’ Choice paper looks at a study from India evaluating satellite habilitation centres for paediatric cochlear implant services. This paper highlights the benefits and challenges for patients and services and these points may be applicable internationally. Thanks as always to all our reviewers for their hard work and contributions.
Nazia Munir and Hannah Cooper
In this article, Arumugam et al. consider whether satellite centres can be viable for rehabilitation of children who have undergone cochlear implantation (CI) in a central hub. Whilst the focus is on developing countries, this article is also highly relevant for all countries – including the UK, where cochlear implantation is corralled into a discrete number of centres for a number of reasons including efficiency and quality of care. As the numbers of patients with cochlear implants increase, the question of the nature and setting of their postoperative care and follow-up becomes increasingly important. In the UK, hub and spoke models have been more popular in some services, but generally not in cochlear implantation. There are concerns that a dilution of expertise and distance from the hub may compromise care. For this reason, there has recently been progress in being able to deliver rehabilitation and device programming from a distance. The patients for whom rehabilitation is most important are children, and so it might be expected that if care were to be compromised, it would be in this group. This study reports the experience of over 1000 children implanted in a little over six years. This represents a high volume of paediatric CI cases, reflecting the population this centre serves. This excludes patients with significant comorbidity and those with cochlear dysplasia. The introduction of four satellite centres improved patient attendance to rehabilitation by around 15% (admittedly the sample assessed prior to the introduction of centres was small). The outcomes were universally good, and indeed the most important outcome was that the attendance and outcomes from children attending satellite centres was comparable, and in some cases marginally better, than those seen at the hub. It must be remembered that this reflects an experience from a very high-volume centre, which consequently has extensive experience in paediatric cochlear implantation. Furthermore, a high volume may facilitate the introduction of satellite rehabilitation centres. Nevertheless, this study makes it clear that such a model can provide comparable outcomes whilst also improving patient experience.