1064 Impact of a Novel Sleep Medicine Neighborhood Model for Obstructive Sleep Apnea Care. (27th April 2018)

• Record Type: Journal Article
• Authors: Bertisch, S; Barker, D; Sternberg, S; Patel, S
• Is Part Of: Sleep. Volume 41(2018)Supplement 1
• Page Start: A395
• Page End: A396
• Publication Date: 2018-04-27
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsy061.1063
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: Quality of obstructive sleep apnea (OSA) care is currently hindered by administrative requirements for diagnostic testing, limited sleep training among primary care providers (PCPs), and fragmented care between clinicians and durable medical equipment providers, leading to low-value and/or delayed care. We developed and implemented a collaborative neighborhood model for OSA care to improve quality of care, and tested its impact on OSA care processes. Methods: Our multidisciplinary team used mixed-methods to develop and implement a sleep medicine neighborhood, an extension of the patient-centered medical home, which provides the infrastructure to coordinate care between PCPs, specialists, and other care providers. We then conducted a controlled, clustered trial within a large hospital-based primary clinic to assess the effectiveness of the neighborhood on processes of care. Results: Prior to intervention, PCPs ordered 122 diagnostic sleep studies (both at-home and in-lab) in control clinics and 131 patients in intervention clinics over 12 months. During the 12-month intervention period, 179 studies were ordered in control clinics and 209 in intervention clinics. Testing was completed in 48.6% of patients from control clinics vs. 56.0% of patients from intervention clinics (p=0.15). Of those who completed sleep testing, median time from order to completion was 57 days vs. 48 days (p=0.048) in control vs. intervention clinics, respectively. Among patients diagnosed with OSA, evaluation by a sleep specialist occurred in 40.5% vs. 77.7% (p<0.001), and continuous positive airway pressure (CPAP) was prescribed in 54.2% vs. 72.9% (p=0.009) of patients originating from control vs. intervention clinics. Among those prescribed CPAP, the proportion initiating CPAP was 53.3% vs. 61.4% (p=0.03) in control vs intervention clinics. Conclusion: Patients suspected of having OSA commonly experience delays in care during the complex and fragmented processes of diagnostic testing and CPAP initiation. A collaborative care program aimed at coordinating care between PCPs and sleep specialists can improve the timeliness of diagnosing OSA and ability to implement CPAP therapy, thereby improving the quality of OSA care. Support (If Any): American Sleep Medicine Foundation; NIH UL1TR001102.