The Smile House Network in Italy: A Hub-And-Spoke Multidisciplinary Cleft Care Model

Area of Science:

• Craniofacial Surgery
• Public Health
• Healthcare Systems

Background:

• Cleft lip and palate are common congenital conditions requiring extensive, coordinated multidisciplinary care.
• National guidelines advocate for early access, centralized care, and structured follow-up for craniofacial anomalies.
• The Smile House Network was established in Italy to implement a hub-and-spoke model for cleft care delivery.

Purpose of the Study:

• To analyze the 2023 activity volumes of the Smile House Network.
• To evaluate the network's operationalization of a hub-and-spoke model for cleft care.
• To compare network activity with national pathway indicators.

Main Methods:

• Descriptive analysis of 2023 Smile House Network activity volumes.
• Extraction of center-level data on primary and secondary cleft surgeries.
• Quantification of multidisciplinary outpatient care (orthodontic, speech, psychological).
• Comparison with national AGENAS indicators for cleft repair timing and volume.

Main Results:

• The network performed 342 primary and 180 secondary surgical procedures (total 522) in 2023.
• Multidisciplinary care included 2459 orthodontic, 1372 speech therapy, and 409 psychological counseling encounters.
• Surgical activity concentrated in hubs, with high outpatient volumes at selected sites, reflecting the hub-and-spoke model.
• Primary surgical volume aligned with national expectations, indicating model feasibility.

Conclusions:

• The Smile House Network demonstrates mature, system-level implementation of multidisciplinary cleft care.
• The network achieves substantial surgical throughput and high-volume allied-health services.
• Data support the hub-and-spoke model for timely primary repair, sequelae management, and standardized longitudinal follow-up.