An audit of cochlear implant referral in the UK: pilot data suggests health inequalities

Abstract

Introduction: in March 2019, NICE criteria for CI were extended¹. The uptake of CI among adults is low², despite social and economic benefits³.Methods: an AuditBase Crystal Report developed by Auditdata and Cochlear®, with additional input from the clinics that piloted the report, was run between 1 July 2019 and 1 January 2020. 727 adults meeting the NICE audiometric criteria were retrospectively placed into a category: 1 = referred for CI assessment2 = unsuitable for a CI 3 = further assessment needed4= referral declined5= CI not discussedData were compared in Audiology services in the South East (SE, n=195), South West (SW, n=109), and Audiology services linked to CI teams in South London (L, n=184) and the North East (NE, n=239). Results: the proportion of eligible adults referred for CI assessment varied by site; 3% (SE), 19% (SW) 45% (L) and 33% (NE). Patients declining a CI assessment showed the largest variability between services: 92% (SE), 58% (SW) 26% (L) and 36% (NE). The percentage of eligible patients offered a CI assessment was lower at the Audiology sites not linked to a CI team: 33% (SE), 45% (SW), compared to the CI-linked sites: 61% (L) and 51% (NE). Discussion: on average 48% of eligible adults were offered a CI referral, but considerable inequality exists. Evidence suggests referral rates are affected by a number professional and patient factors⁴. Health inequalities may be linked to rates of decline⁵. Pilot results support a national Audit of CI referral. References 1 = NICE (2019) https://www.nice.org.uk/guidance/ta566 2 = Buchman et al. (2020) doi:10.1001/jamaoto.2020.0998 3 = Archbold et al (2014) https://www.heartogether.org.uk/research/adult-strategy-reports/the-real-cost-of-adult-hearing-loss-2014 4 = Bierbaum et al (2020) DOI: 10.1097/AUD.0000000000000762 5 = Gov.uk (2019) English indices of deprivation. https://www.gov.uk/government/statistics/english-indices-of-deprivation-2019 Conflict of interest: Cochlear® funded the development of the Crystal Report and supported Audiologists to run the report but they did not have access to the data once collected and did not contribute to the analysis or write up of the results. <br/