Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life

Chai-Coetzer, Ching Li; Antic, Nicholas; Rowland, Lesley; Reed, Richard; Esterman, Adrian; Catcheside, Peter; Eckermann, Simon; Vowles, Norm; Williams, Helena; Dunn, Sandra; McEvoy, R. Doug

doi:10.1001/jama.2013.1823

Cited by 172 publications

(134 citation statements)

References 25 publications

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“…A recent multicenter randomized controlled trial did not find a difference in PAP adherence between care rendered by sleep specialists versus primary care physicians in patients with OSA. 9 In this efficacy study, controlled multiple educational interventions were delivered to sufficiently train nurses and primary care physicians who then managed patients in a wellcontrolled and protocolized manner that resulted in non-inferior results compared to sleep specialists. 9 However, in our effectiveness study, we conducted our study in the real-world setting with typical interventions delivered by regular staff members without any special educational intervention administered to health care providers.…”

Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

“…9 In this efficacy study, controlled multiple educational interventions were delivered to sufficiently train nurses and primary care physicians who then managed patients in a wellcontrolled and protocolized manner that resulted in non-inferior results compared to sleep specialists. 9 However, in our effectiveness study, we conducted our study in the real-world setting with typical interventions delivered by regular staff members without any special educational intervention administered to health care providers. Such differences between controlled trials and comparative effectiveness studies are important translational elements in health services research that bear much import to outcomes research and public health relevance.…”

Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

“…22,23 Additionally, we cannot exclude the fact that differences in the US and Australian health care systems may have contributed to the observed differences. 9 Accreditation of health service systems is widely considered to be a driver of quality. 24 However, the effect of such accreditation on healthcare quality is stated to be uncertain and warranting more study.…”

Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

“…7 Subsequently, Pamidi and colleagues performed a single-center retrospective chart review that demonstrated higher objective measures of PAP adherence in patients seen by a sleep specialist prior to undergoing polysomnography (PSG) of sleepiness, patient satisfaction, or PAP adherence. 9 So far, to our knowledge, a comparative effectiveness trial, in "realworld" circumstances devoid of the artificial constraints of a randomized controlled trial, comparing the effect of both physician certification and center accreditation on clinical outcomes in patients with OSA has not been performed.…”

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confidence: 99%

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

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

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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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Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

Section: Efficacy Effectiveness and Health Policymentioning

confidence: 99%

mentioning

confidence: 99%

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

Parthasarathy

Subramanian²,

Quan

2014

Journal of Clinical Sleep Medicine

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“…More emphasis needs to be given to delivering high-value prevention, wellness, screening and health maintenance services at the primary care level, integrated with relevant specialist providers. 93 Examples of such integrated practice include area-wide hospital substitution programs, 94 hospital-wide patient flow programs, 95 reconfigured emergency-acute care systems based on patient complexity and urgency, 96,97 collaborative primary care specialist teams based in non-hospital settings caring for patients with chronic diseases, 98,99 primary care substitution of specialist services 100 and multidisciplinary, patient-centred medical homes. 101 …”

Section: Convert Health Care Institutions Into Rapidly Learning Organmentioning

confidence: 99%

Ten clinician-driven strategies for maximising value of Australian health care

Scott¹

2014

Aust. Health Review

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Objective. To articulate the concept of high-value care (i.e. clinically relevant, patient-important benefit at lowest possible cost) and suggest strategies by which clinicians can promote such care in rendering the Australian healthcare system more affordable and sustainable.Methods. Strategies were developed by the author based on personal experience in clinical practice, evidence-based medicine and quality improvement. Relevant literature was reviewed in retrieving studies supporting each strategy.Results. Ten strategies were developed: (1) minimise errors in diagnosis; (2) discontinue low-or no-value practices that provide little benefit or cause harm; (3) defer the use of unproven interventions; (4) select care options according to comparative cost-effectiveness; (5) target clinical interventions to those who derive greatest benefit; (6) adopt a more conservative approach nearing the end of life; (7) actively involve patients in shared decision making and self-management; (8) minimise day-to-day operational waste; (9) convert healthcare institutions into rapidly learning organisations; and (10) advocate for integrated patient care across all clinical settings.Conclusions. Clinicians and their professional organisations, in partnership with managers, can implement strategies capable of maximising value and sustainability of health care in Australia.What is known about this topic? Value-based care has emerged as a unitary concept that integrates quality and cost, and is being increasingly used to inform healthcare policy making and reform. What does this paper add? There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap. What are the implications for practitioners? If all practitioners, in partnership with healthcare managers, attempted to enact all 10 strategies in their workplaces, a significant quantum of healthcare resources could be redirected from low-to highvalue care, culminating in much greater health benefit from the healthcare dollars currently being spent. However, such reforms will require a shift in clinician thinking and practice away from volume-based care to value-based care.

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Management Setting of Obstructive Sleep Apnea

Weingarten¹,

Basner²

2013

JAMA

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Obstructive sleep apnea (OSA) is associated with cognitive impairment, daytime sleepiness, and cardiovascular and cerebrovascular morbidity and mortality. Continuous positive airway pressure (CPAP) remains the primary treatment for this disorder, and recent data provide novel insight regarding optimal CPAP application and compliance. Promising alternate forms of OSA treatment have also been addressed with recent clinical research.

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Primary Care vs Specialist Sleep Center Management of Obstructive Sleep Apnea and Daytime Sleepiness and Quality of Life

Cited by 172 publications

References 25 publications

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

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

Ten clinician-driven strategies for maximising value of Australian health care

Management Setting of Obstructive Sleep Apnea

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