The evolution of clinical models for cochlear implant (CI) management: The role of telepractice

BACKGROUND: Less than 10% of adults with a significant acquired hearing loss that could benefit from a cochlear implant (CI) receive one . Awareness, access, and organisational capacity emerge as key barriers to a CI journey. Once on the CI journey, barriers to accessing the multiple different elements within a CI service model, and disruptors, such as the recent COVID 19 pandemic can interrupt the CI users experience. AIMS: This thesis aimed to improve access and effectiveness of CI services in Australia by:

i developing an evaluation framework to assess care models;

ii systematically modifying two aspects of the care pathway through the use of telepractice (i.e., device programming and speech perception assessment) and evaluating these using the framework developed (in aim i);

iii determining the barriers for implementation and scale; and

iv designing an integrated model of care to expand access, effectiveness, and efficiency.

The dynamic nature of technology is leading to an inevitable merging of roles and responsibilities between the organisational and psychosocial frameworks within the CI care models. It is the intent of this theses to identify the critical factors that can facilitate a robust and seamless evolution of future models of CI care accordingly. METHOD: This is a mixed-methods study which included: (i) the development of an evaluation framework for the effectiveness and efficiency for telepractice; (ii) the development and qualitative and quantitative evaluation of remote mapping completed in 42 paediatric and adult CI users (Chapter 3); (iii) the development and qualitative and quantitative evaluation of an app to deliver speech perception assessments remotely as evaluated with 23 adults (Chapter 4); and (iv) semi-structured interviews to understand the perceptions and experiences of CI services with 24 adults who at various stages of their CI journey (Chapter 5).The key domains of interventional approaches (organisational, technological, and psychosocial, adapted from (Hogan, 2001) in a CI journey were used to formulate a model for evaluating potential telepractice methodologies that could mitigate current gaps in service delivery. RESULTS: The evaluation confirmed the feasibility and usability of providing components of a CI service using telepractice. Some limitations to providing a continuous service through telepractice were identified. Qualitative schema analyses identified deficiencies in aspects of the CI model of care, irrespective of service methodology. Knowledge, support, empowerment, and disruption were identified as key themes within the CI journey impacting the experience requiring consideration in delivering CI model of care. CONCLUSION: Telepractice is a feasible enabler for episodes of CI care. It can mitigate barriers to accessing services, increase clinical capacity and has the potential to provide empowerment through enabling the PSHL to collaborative in their care. Seamless models of CI care for adults CI users irrespective of the methodology used must consider the psychosocial, organisational, and technological domains of the “CI ecosystem”. Improved knowledge, support and empowerment enhancements were required to mitigate barriers and challenges enabling a collaborative and sustainable experience for all stakeholders.