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Multi-Modal Home Sleep Monitoring in Older Adults
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Evaluating the feasibility of implementing a Telesleep pilot program using two-tiered external facilitation.

Nicholas A Rattray1,2,3,4,5, Andrew Khaw6, Mackenzie McGrath6

  • 1VA Health Services Research & Development Center for Health Information and Communication (CHIC), Veterans Health Indiana, Roudebush VAMC, Indianapolis, Indiana, USA. nrattray@iupui.edu.

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Summary

Remote monitoring for obstructive sleep apnea (OSA) using positive airway pressure (PAP) showed similar effectiveness to in-person care. This approach reduced visit times and travel, improving access to sleep medicine services.

Keywords:
Disease managementImplementation scienceOutcomesQuality improvementSleep apneaSleep medicineTelehealth

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Area of Science:

  • Sleep Medicine
  • Health Services Research
  • Implementation Science

Background:

  • Obstructive sleep apnea (OSA) significantly impacts patient health and outcomes.
  • Positive airway pressure (PAP) therapy is a primary treatment for OSA.
  • Remote monitoring of PAP may enhance access to sleep medicine care compared to traditional in-person visits.

Purpose of the Study:

  • To assess the feasibility of a clinical program for OSA treatment via PAP remote monitoring.
  • To evaluate the effectiveness of external facilitation as an implementation strategy for this program.

Main Methods:

  • A prospective, mixed-methods study evaluated two models: usual care (in-person) and Telehealth nurse-delivered remote monitoring for OSA patients at a VAMC.
  • Preliminary effectiveness outcomes included PAP adherence and apnea-hypopnea index (AHI).
  • A two-tiered external facilitation strategy was employed, involving interviews with clinical staff.

Main Results:

  • PAP adherence and disease severity (AHI) were comparable between remote monitoring and in-person care groups.
  • Remote monitoring visits were 50% shorter and saved an average of 72 miles in travel.
  • A two-tiered external facilitation model was crucial for program implementation, overcoming barriers and ensuring patient enrollment and treatment.

Conclusions:

  • Remote PAP monitoring is a viable alternative to in-person services for veterans with OSA, demonstrating similar efficacy.
  • The study highlights the importance of a structured, 'two-tiered' external facilitation approach for complex implementation projects.
  • This model effectively supports interdisciplinary collaboration and improves access to care in sleep medicine.