Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.

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Insomnia is defined by difficulty falling asleep, staying asleep, or waking earlier than desired with inability to return to sleep. Complaints of nonrestorative sleep (NRS) are often associated with insomnia but can occur independently. Fragmented sleep and NRS have been shown to relate to one's mood, one's ability to process their own or others' emotions, and can lead to changes in cognitions and behaviors. Personality traits related to increases in anxiousness may play a role in the development and maintenance of sleep disorders and associated daytime impairment of NRS. The relations between sleep disturbance, personality traits, and trait emotional intelligence are underrepresented in the current literature and findings have been mixed. This study addressed some inconsistencies by identifying associations between the Big Five personality traits, trait emotional intelligence (TEI), complaints of NRS, and disrupted sleep associated with insomnia. We predicted that neuroticism would relate to poorer sleep and that conscientiousness and TEI would be associated with better sleep. Openness to experience, extraversion, and agreeableness are not often discussed in the literature, but were expected to associate similarly as conscientiousness. Results provided support for the idea that trait characteristics are associated with insomnia severity and restorative sleep quality. These findings indicated that personality and TEI may play a role in development and maintenance of sleep disorders and daytime impairment of NRS; higher conscientiousness, lower neuroticism, and higher TEI possibly demonstrate a protective role to experiencing negative effects of poor sleep.

Objective: Insomnia identity refers to the conviction that one has insomnia, which can occur independently of poor sleep. Night-to-night variability in sleep (termed intraindividual variability (IIV)) may contribute to insomnia identity yet remain undetected via conventional mean analyses. This study compared sleep IIV across four subgroups: noncomplaining good sleepers (NG), complaining poor sleepers (CP), complaining good sleepers (CG), and noncomplaining poor sleepers (NP). Methods: This study analyzed 14 days of sleep diary data from 723 adults. Participants were classified according to presence/absence of a sleep complaint and presence/absence of poor sleep. A 2×2 multivariate analysis of covariance (MANCOVA) was performed to explore differences on five measures of sleep IIV: intraindividual standard deviation in total sleep time (iSD TST), sleep onset latency (iSD SOL), wake after sleep onset (iSD WASO), number of nightly awakenings (iSD NWAK), and sleep efficiency (iSD SE). Results: MANCOVA revealed significant main effects of poor sleep, sleep complaint, and their interaction on sleep IIV. Poor sleepers exhibited greater IIV across all sleep parameters compared to good sleepers. Similarly, individuals with a sleep complaint exhibited greater IIV compared to individuals with no complaint. The interaction revealed that iSD SOL was significantly greater among CP than NP, and iSD NWAK was significantly greater among CG than NG. Conclusions: Greater night-to-night variability in specific sleep parameters was present among complaining versus noncomplaining sleepers in good and poor sleep subgroups. These findings suggest certain aspects of sleep consistency may be salient for treatment-seeking individuals based on their quantitative sleep status.

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Nonrestorative sleep (NRS), characterized by a lack of refreshment upon awakening, has received little attention in the sleep literature even though it can occur and cause impairment apart from other sleep difficulties associated with insomnia. The Restorative Sleep Questionnaire (RSQ) is one of the first validated self-report instruments for investigating NRS severity, presenting new opportunities to explore what factors predict and perhaps contribute to unrefreshing sleep. The present study sought to determine whether inherent circadian preference for morning or evening activity, known as chronotype, predicted restorative sleep in 164 college undergraduates who completed daily RSQs over 2 weeks. The participants who endorsed greater orientation to evening activity on the morningness-eveningness questionnaire reported significantly less average restorative sleep across their full sampling period, and this association was maintained after accounting for demographic factors, number of sleep-relevant psychiatric and medical diagnoses, sleep diary parameters, self-reported status as an insomniac and ratings of sleep quality. When analyses were conducted separately for weekday and weekend RSQ scores, eveningness predicted NRS independently of extraneous variables only during the workweek, not during Saturday and Sunday. These findings have implications for the developing conceptualization of NRS, and continue the work of elucidating the interconnections between common sleep disturbances and the circadian system.

The present investigation sought to extend extant research on subjective sleep complaints by examining their relation to perceived sleep norms. Results from two studies showed that individuals' distress and illness behavior in response to symptoms of fatigue and non-restorative sleep was influenced by their perceptions of peer norms for those symptoms. Individuals who believed they experienced a greater degree of fatigue and non-restorative sleep than their peers reported more distress arising from those symptoms, and were also more likely to seek social support and medical treatment for them. Furthermore, participants who scored higher in neuroticism were more likely to believe they experienced worse fatigue and non-restorative sleep than their peers, and thus reported higher symptom-related distress, and higher likelihood of engaging in illness behaviors. These results provide preliminary evidence of the clinical relevance of perceived norms in the way individuals respond to and manage sleep related problems.