Increasing capacity for epilepsy self-management via a hub and spoke implementation model: Clinician perspectives from epilepsy centers in the United States

Elaine T Kiriakopoulos; Laura Bernstein; Trina Dawson; Lisa Feeley; Barbara C Jobst; Sarah J Kaden; Sharon O'Connor

doi:10.1016/j.yebeh.2025.110865

Increasing capacity for epilepsy self-management via a hub and spoke implementation model: Clinician perspectives from epilepsy centers in the United States

Epilepsy Behav. 2026 Jan 6:176:110865. doi: 10.1016/j.yebeh.2025.110865. Online ahead of print.

Authors

Elaine T Kiriakopoulos¹, Laura Bernstein², Trina Dawson³, Lisa Feeley², Barbara C Jobst⁴, Sarah J Kaden³, Sharon O'Connor²

Affiliations

¹ Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; The Department of Neurology, Dartmouth Health, Lebanon NH, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover NH, USA. Electronic address: elaine.t.kiriakopoulos@dartmouth.edu.
² The Dartmouth Institute for Health Policy and Clinical Practice, Hanover NH, USA; The Center for Program Design and Evaluation, Dartmouth College, Hanover NH, USA.
³ The Department of Neurology, Dartmouth Health, Lebanon NH, USA.
⁴ Geisel School of Medicine at Dartmouth College, Hanover, NH, USA; The Department of Neurology, Dartmouth Health, Lebanon NH, USA.

PMID: 41500116
DOI: 10.1016/j.yebeh.2025.110865

Abstract

Rationale: HOme-Based Self-management and COgnitive Training CHanges Lives (HOBSCOTCH) is a novel telehealth self-management program aimed at improving cognitive function and quality of life for people with epilepsy. Using a Hub and Spoke model, the HOBSCOTCH Institute at Dartmouth Health partnered with epilepsy center clinics across the U.S. in the HOBSCOTCH Institute Translational Network (HITN) to examine facilitators and barriers to epilepsy self-management program implementation.

Methods: Key informant interviews were conducted with 16 clinician champions from geographically diverse epilepsy centers using a semi-structured guide to explore clinic-level and patient-level factors influencing HOBSCOTCH implementation. Transcripts were analyzed using deductive coding to identify barriers, facilitators, and contextual dynamics shaping program integration.

Results: Findings suggest that the program design, relying on both patient referral to the centralized HOBSCOTCH Institute Hub and onsite Spoke delivery, is well supported by providers. Implementation barriers identified as requiring consideration included technology challenges, language barriers, staffing capacity for program delivery onsite, and readiness of quality improvement systems.

Conclusions: There is increasing recognition of the need to integrate evidence-based self-management into epilepsy clinical care streams. Clinician education and real-world implementation strategies will need to address contextual challenges for broad-based implementation and increased patient access to self-management supports. Access pathways, intervention delivery models, interdisciplinary collaboration, and tailored support will be required to scale epilepsy self-management programs effectively.

Keywords: Cognitive health; Epilepsy center engagement; Evidence-based epilepsy self-management; Program implementation.