The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients’ Satisfaction, and Outcome in a Large Health Provider System

Abstract

During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients' satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P < 0.05). 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients' satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; P = 0.11). Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients' satisfaction remained similarly high. The total direct cost of OSA management was reduced.

Lateral pharyngeal wall collapse associated with hypoxemia in obstructive sleep apnea

“…Among 64 patients, two received home sleep tests; however, in both, all variables involved were reported. Previous studies suggest that there is good agreement between respiratory variables on home sleep tests and standard PSG . Due to the subjective nature of DISE, it may be inherently prone to inconsistencies; however, previous studies have reported acceptable consistency for DISE.…”

“…Previous studies suggest that there is good agreement between respiratory variables on home sleep tests and standard PSG. [28][29][30][31] Due to the subjective nature of DISE, it may be inherently prone to inconsistencies; however, previous studies have reported acceptable consistency for DISE. Kezirian et al found that the inter-rater reliability of DISE is moderate to substantial.…”

Improvement in BMI z-score following Adenotonsillectomy in Adolescents Aged 12-18 Years: A Retrospective Cohort Study

“…Clalit Health Services is the largest health maintenance organization in Israel, insuring over 4.5 million people. It keeps a very strict registry of patients records, physician visits and surgeries, several studies were published based on queries of this registry [30][31][32]. Each pediatrician (or ENT) visit is recorded in this registry, and pediatricians are encouraged to measure weight and height at least annually and record it in the registry.…”

Trends in sleep studies performed for Medicare beneficiaries

“…In addition to shorter wait times, the implementation of HST is associated with overall improved access to sleep testing. 19,20 According to a study by Stewart et al, both the number of HST and PSG procedures performed annually increased, and the OSA diagnosis rate remained constant, suggesting that appropriate referrals are being made. 20 By offering HST to qualified patients, more patients with undiagnosed OSA may be identified, and PSG can be prioritized for patients who are unable to complete an HST.…”