ABSTRACT #52

STAY IN BED: INCREASING UTILIZATION OF HOME SLEEP TESTS AT THE IMA CLINIC

Stephen McCroskery, Jessica Farley, Julie Huang, Mitchell Gronowitz, Zachary Roberts, Jing Wang

PURPOSE AND GOALS: Obstructive sleep apnea (OSA) is a prevalent and underdiagnosed condition associated with significant morbidity and mortality. While in-lab polysomnography remains the gold standard diagnostic method, home sleep apnea testing (HSAT) has many advantages including lower cost, increased comfort, and greater accessibility, providing an avenue for quicker diagnosis and treatment of OSA. Our goal was to increase the number of HSATs ordered from the IMA Resident Clinic by 20% over six months.

METHODS: We interviewed residents at the IMA Clinic to better understand the HSAT ordering process from the initial patient encounter to receiving the sleep study results. Based on these conversations, we identified key issues such as lack of knowledge regarding insurance coverage, confusion about HSAT contraindications,and ambiguity regarding who coordinates the delivery and interpretation of each study. We addressed these issues by making appropriate changes to the IMA app -- an online repository of clinical manuals for IMA residents -- disseminating an instructional video to residents and giving a lecture to IMA Attendings. Additionally, we sent a monthly email to the IMA Firm with the fewest HSAT orders, reiterating the benefits of HSATs and summarizing the ordering process.

EVALUATION PLAN: The number of HSAT orders from the IMA Clinic each month were tallied.

SUMMARY OF RESULTS: The changes to the IMA App were updated on June 31, 2022 marking the start date of our interventions. The preceding four months were used for baseline analysis. The average number of HSATs ordered during the preceding four months was 17.25 tests/month. Over the next 5 months, from July through November, there were an average of 31 tests/month, representing a 79.7% increase. Therefore, editing the IMA App and providing education to residents and attendings effectively increased HSAT orders, although parsing the relative effectiveness of each intervention is not possible as they occurred within a short time span.

REFLECTIVE CRITIQUE: While interviews with IMA residents gave our team an in-depth understanding of the barriers to HSAT ordering, it did not allow for quantitative measures of resident knowledge before and after interventions.

Monitoring the number of HSAT orders from the IMA clinic was an effective proxy for resident knowledge. Soliciting resident attitudes could shed-light on the relative effectiveness of the interventions which could be useful for education-based quality improvement projects going forward.

Further, while we successfully increased the number of HSAT orders at the IMA clinic, more data analysis is required to determine whether our overall goal of decreasing time from suspected OSA to diagnosis and treatment was achieved. Barriers that remain include ensuring delivery and completion of HSATs along with timely connection to sleep medicine for treatment after diagnosis. We have a secondary analysis that is ongoing to identify these potential issues, which could be avenues for future QI interventions.