A Multicenter Prospective Comparative Effectiveness Study of the Effect of Physician Certification and Center Accreditation on Patient-Centered Outcomes in Obstructive Sleep Apnea

Abstract

than those who did not receive such sleep specialist consultation. 8 Recently, a randomized controlled non-inferiority trial reported that treatment of OSA by primary care physicians was non-inferior to that of sleep specialists with regard to resolution Objectives: To study the effect of sleep center accreditation and Sleep Medicine board certifi cation of physicians on patient-centered outcomes in obstructive sleep apnea (OSA). Design: Prospective, multicenter, comparative effectiveness study. Setting: Four sleep centers Patients: 502 patients with OSA. Interventions: None. Measurements and Results: Patients at two accredited and two non-accredited centers underwent polysomnography at participating locations and completed validated questionnaires, with objective measurement of positive airway pressure (PAP) therapy adherence performed three months after therapy initiation. The proportion of patients (age 53 ± 13[SD] years; 26% women; and body mass index 33.6 ± 7.2 kg/m 2 ) who were adherent to PAP therapy by Medicare guidelines (> 70% of nights with ≥ 4 h use over a 30-day period) was greater in accredited (79%) than non-accredited sites (64%; p = 0.004). After adjustment for confounding variables, patients who received care from accredited centers (odds ratio [OR] 2.2, 95% confi dence interval [CI], 1.2-4.2; p = 0.016) and certifi ed physicians (OR 2.3, 95% CI, 1.3-4.0; p = 0.005) were more likely to be adherent to PAP therapy than those who received care from non-accredited centers and non-certifi ed physicians. Patient satisfaction was associated with greater education received from physician (OR 4.6; 95% CI 2.3-9.3); greater risk perception (OR 2.7; 95% CI 1.0-7.4); physician certifi cation (OR 2.1; 95% CI 1.1-4.2); and inversely related to delays in care (OR 0.5; 95% CI 0.3-0.9; p < 0.05). Such delays were inversely related to accreditation-certifi cation status (p < 0.0001). Conclusions:In patients with OSA, accreditation-certifi cation status of sleep centers and physicians was associated with better PAP adherence, better patient education, better patient satisfaction, and greater timeliness. S C I E N T I F I C I N V E S T I G A T I O N SH ealth care delivery in many disease conditions including obstructive sleep apnea (OSA) will be increasingly driven by quality metrics.1-3 One of the important quality metrics for OSA-adherence to positive airway pressure (PAP) therapyremains a huge problem, with adherence of greater than four hours of daily use ranging from 46% to 83%. 4,5 There is much emphasis on patient-centered care that focuses on outcomes relevant to patients such as improving patient satisfaction and enhancing the patient experience. 6 We have previously shown that in a cross-sectional national survey, patients with OSA cared for by American Academy of Sleep Medicine (AASM) accredited sleep centers or Sleep Medicine board-certifi ed physicians had lower positive airway pressure (PAP) discontinuation rates and reported greater patient satisfaction than patients cared for by non-accredited cent...

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Sleep Medicine Board Certification Status of Physicians and American Academy of Sleep Medicine Sleep Center Accreditation Improves Healthcare Outcomes in Obstructive Sleep Apnea Patients Treated with Positive Pressure Therapy. It's Not Complicated!

“…Limitations of the work by Parthasarathy and companions 10 are largely adequately addressed in the manuscript. The study design was intended to limit participation to those patients having OSA without secondary confounding disorders.…”

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“…When properly aligned, sleep specialists and AASM accredited centers can positively influence outcomes. 19 However, there is a large segment of our population who has limited access to a sleep specialist. Accordingly, the Academy has started efforts to develop policies and best practices to standardize and appropriately promote telehealth sleep services.…”