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Continuous positive airway pressure care for pediatric obstructive sleep apnea: A long-term quality improvement

Melissa S Xanthopoulos1,2, Ariel A Williamson1,2,3, Caroline C Burlingame4

  • 1Sleep Center, Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Pediatric Pulmonology
|July 14, 2022
PubMed

Insights

A quality improvement initiative improved pediatric obstructive sleep apnea syndrome (OSAS) care by enhancing follow-up visits and post-treatment monitoring with continuous positive airway pressure (CPAP). This led to better patient outcomes and reduced healthcare utilization.

Area of Science:

  • Pediatric Pulmonology
  • Sleep Medicine
  • Quality Improvement Science

Background:

  • Treating pediatric obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) presents challenges in adherence and follow-up.
  • Effective management requires addressing behavioral, technical, medical, and systemic factors in outpatient care.

Purpose of the Study:

  • To enhance outpatient CPAP care for pediatric OSAS through a multidisciplinary quality improvement (QI) initiative.
  • To increase timely follow-up visits, reduce time to first follow-up, and improve post-initiation polysomnogram rates.
  • To explore the impact of improved CPAP care on healthcare utilization (HCU).

Main Methods:

  • Implemented a QI initiative involving physicians, nurses, psychologists, and respiratory therapists.
  • Developed a patient tracking system and standardized interdisciplinary clinical care processes.
  • Monitored key performance indicators: follow-up visit proportion within 4 months, median time to first follow-up, and post-initiation polysomnogram rates.

Main Results:

  • The proportion of patients with follow-up within 4 months increased from 38.2% to 65.5%.
  • Median time to first follow-up visit decreased from 133 to 56 days.
  • 71.1% of patients obtained a post-initiation polysomnogram within 1 year, exceeding the 50% goal. Significant reductions in emergency department and hospitalization lengths of stay were observed post-CPAP initiation.

Conclusions:

  • A standardized, tracked, interdisciplinary approach to outpatient CPAP care significantly improves follow-up adherence and monitoring for pediatric OSAS.
  • This QI initiative demonstrates potential for reducing healthcare utilization in pediatric OSAS patients using CPAP.
  • Optimizing CPAP care processes is crucial for improving clinical outcomes and resource management in pediatric sleep apnea.

Keywords:
childcontinuous positive airway pressureobstructivequality improvementsleepsleep apnea

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