Models of service delivery in adult cochlear implantation: A scoping review of delivery arrangements

Azadeh Ebrahimi-Madiseh, Mansoureh Nickbakht, Robert Eikelboom, Bec Bennett, Peter Friedland, Marcus Atlas, Rebecca Jessup

Research output: Contribution to journalArticlepeer-review


Background: To inform decisions about service delivery improvement, this study aimed to describe available evidence of cochlear implantation delivery arrangements in adults, the outcomes by which these services are measured.
Methods: Scoping review of all English language, primary studies conducted on adults (≥18 years) with ten or more subjects, published between January 2000 and December 2020, which assessed the effects of delivery arrangements of cochlear implantation or any other intervention in conjunction were included. MEDLINE, EMBASE, CINAHL Plus, AMED, PsycINFO, LILACS, KoreaMed, IndMed, Cochrane CRCT, ISRCTN registry, WHO ICTRP and Web of Science were searched. Included studies had to provide evidence on at least one of the following outcomes: patient outcomes, quality of care, access or use of healthcare services, resource use, impacts on equity or social outcomes, healthcare provider outcomes, adverse effects, knowledge, attitude or performance in a test. Criteria for systematic reviews, delivery arrangement category and outcome type, based on Cochrane Effective Practice and Organisation of Care taxonomy was included in data extraction. Data was narratively synthesised based on EPOC categories.
Results: Two-hundred and eighty-three studies fulfilled the inclusion criteria. Around 40% of the studies investigated how care is delivered, focusing on quality and safety systems. New care pathways to coordinate care and the use of information and communication technology to deliver care were emerging areas. There was little evidence on continuity, coordination and integration of care and how the workforce is managed. No studies investigated where care is delivered and changes to the environment. The main outcomes measured in the studies were the patient outcome of health status and performance in a test.
Conclusion: Substantial evidence exists regarding the safety and quality of CI in adults, predominantly focused on surgical aspects. Digital health is an emerging area with a significant application in improving CI services and better allocation of resources. There is a gap in knowledge about how patients and broader stakeholders view CI experiences and the associated costs in the whole cycle of care. Addressing these knowledge gaps would provide a better understanding of the value of care models, opening opportunities for innovative and integrated solutions.
Original languageEnglish
JournalBMC Health Services Research
Publication statusSubmitted - 3 Apr 2022


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