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Observational Study
. 2025 Mar 18;25(1):398.
doi: 10.1186/s12913-025-12459-5.

Hub-and-Spoke regional system supported by telehealth for managing coeliac disease in Liguria: a mixed-methods survey followed by an observational pilot study

Marco Crocco #  1 , Federica Malerba #  2   3 , Paolo Gandullia  2 , Noemi Zampatti  3 , Maria Franca Corona  4 , Monica Barrani  4 , Massimiliano Leoni  4 , Sara Ceresoli  3   4 , Andrea Gazzolo  5 , Alberto Gaiero  6 , Riccardo Borea  7 , Alessandro Giorgio Lo Curto  7 , Maria Paola Ierardi  8 , Silvia Scelsi  9 , Giuseppe Spiga  10 , Raffaele Spiazzi  11 , Renato Botti  12 , Marisa Alberti  11
Affiliations
Observational Study

Hub-and-Spoke regional system supported by telehealth for managing coeliac disease in Liguria: a mixed-methods survey followed by an observational pilot study

Marco Crocco et al. BMC Health Serv Res. .

Abstract

Background: Due to the need to reorganize the care network for the national screening mandated by law, a new healthcare model was required for the management of coeliac disease. The hub-and-spoke model is a new healthcare organizational system, here we describe its application (supported by telehealth), in the management of pediatric coeliac disease (CD) in Liguria. The results of the pilot phase are presented and the system's strengths and weaknesses discussed.

Methods: A mixed-methods survey followed by an observational pilot study was performed. A multiphase approach was used including preparation setting, operative planning and application. The pilot phase involves a single primary center. The reduction of families' expenditure and environmental impact was assessed using the Viamichelin calculator.

Results: A regional meeting followed by a survey (specifically developed for this study) and a needs analysis highlighted the priority to have an efficient, up to date and homogeneous model of care assistance throughout the network. A diagnostic and therapeutic care pathway (PDTC) was developed by the regional working group. The project involved 986 Ligurian families and allowed a 90% reduction in the distance traveled by families residing within the pilot center's catchment area, saving €177 and 113 kg of CO2 on average per family per year.

Conclusions: The Gaslini Diffuso hub-and-spoke system for managing CD in Liguria exemplifies a commitment to enhancing healthcare efficiency and patient care, reducing environmental impact and cost for both family and healthcare system.

Keywords: Celiac disease; Hub and spoke; Management; gluten; Telehealth; Telemedicine.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The protocol was approved by the Regional Ethics Committee (Liguria: 133/2024—DB id 13773, 29/04/2024). Informed consent to participate was obtained from all of the participants/parents in the study. Consent for publication: Written informed consent for publication of the patient’s clinical details was obtained from the patients/parents. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of decision-making and organizational processes. Preparation setting, operative planning and application of Giannina Gaslini Institute hub-and-spoke system for managing coeliac disease in Liguria. CD = coeliac disease; PDTC = diagnostic and therapeutic care pathway; RRC = Regional Reference Center
Fig. 2
Fig. 2
Aims and expected results of diagnostic and therapeutic pathway for managing coeliac disease (CD) in spokes
Fig. 3
Fig. 3
Algorithm for suspected new cases of coeliac disease in childhood in Liguria. Flow chart to adopt in suspected new cases of coeliac disease in childhood with related responsibility for the different levels of care. Adapted from ESPGHAN Guideline [21]. CD = coeliac disease; DGP = anti deamidated gliadin (EliA GliadinDP IgG, Phadia AB, Uppsala, Sweden); EGDS = esophagogastroduodenoscopy; EMA = anti endomysium; TTG = anti transglutaminase (ELiA Celikey kit, Phadia AB, Uppsala, Sweden)
Fig. 4
Fig. 4
Algorithm for follow up of coeliac disease in childhood in Liguria. Flow chart to follow up of coeliac disease in childhood. CD = coeliac disease; GFD = gluten free diet
Fig. 5
Fig. 5
Hub-and-Spoke centers for the management of coeliac disease in Liguria
See this image and copyright information in PMC

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