1. Adherent Sleep Apnea Patients – What is the effect of diagnosis and adherence level on inpatient outcomes? Adhe rent But… A Genesis Medical Center Research Study And the Variables Affecting this Category of Patients Presented by Jon Lemke, PhD and Desyree Weakley, RN, CCRC Contributions by Alyssa Barkalow, RT and Neil Flynn

2. Sleep Apnea Risk Groups 3. No Dx-Probable Sleep Apnea 4. No Dx-Unlikely to have Sleep Apnea 1. Dx-Adherent 2. Dx-Nonadherent 6/18/2015 Lemke, GHS Business Intelligence Center

3. Adherent Sleep Apnea Patients – What is the effect of diagnosis and adherence level on inpatient outcomes? Adherent But … A Genesis Medical Center Research Study And the Variables Affecting this Category of Patients Presented by Jon Lemke, PhD and Desyree Weakley, RN Contributions by Alyssa Barkalow, RT and Neil Flynn

4. Adherent?

5. Adherent… But… Equipment is malfunctioning But… Not using equipment properly But… Noncompliant usage But… Cushion is leaking But… Headgear is stretched But… Unsure when to replace supplies But… Unsure of insurance coverage But… Do not take it when traveling

6. Adherent… But… “I just got my machine” But… “I don’t need it every night” But… “I take it off in the middle of night” But… “I fall asleep on the couch and forget to use it” But… “I feel claustrophobic” But… “I don’t like my mask” But… “I’m in the hospital, I don’t need it” But… “I had heart disease before I got my PAP”

7. Major Diagnostic Category AdherentNonadherentProbableUnlikelyCases Elective1288598675986 Nonelective5456166972,7894,647 All Circulatory System 6737017953,4645,633 Odds Ratios SA Dx or Probable vs. Unlikely 1.44 (1.19, 1.76) More Likely to Have Sleep Apnea SA Dx vs. Probable 0.77 (0.54, 1.08) Less Likely to Have a Diagnosis of Sleep Apnea Adherent vs. Nonadherent 0.59 (0.39, 0.87) Less Likely to be Adherent Circulatory System: Nonelective 7.17 times the OFI’s than Elective

8. Presentation Objectives  Discuss Variables in the Adherent Category (“Adherent But…”) Explain the Purpose and Objectives of the Adherent, But… Study Describe Sleep Apnea Adherence Relevant to Genesis CV Patients Discuss Realities & Challenges of the Study

9. 2/11/2015 Adherent - but Lemke, GHS Business Intelligence Center

10. Study Purpose & Objectives Categorize Adherent patients based on reason for sleep study referral & level of adherence into 4 groups by: ◦ Medically driven PAP treatment vs. non-medically driven (sleep apnea symptoms) ◦ Fully adherent vs. not fully adherent Identify & compare mortality rates, length of stay, complication rates, & 30 day readmission rates of each category Identify number of Adherent patients who replace masks within 90 days

11. Study Flow Genesis cardiac patients with SA using PAP device = Adherent Enter the CRC Screen CSU & CIU Identify potential subject Discuss pt with RN Informed Consent Decline Adherent Adherent Survey Data collection: 90d SA history, H&P, current admission, 30d re-admit, 90d resupplies Not Sleep Apneic Non- Adherent Other

12. The Journey so Far… Screening on CSU & CIU began May 27 th One week feet to the pavement: ◦ 90 patients screened ◦ 66 with no SA diagnosis  Unlikely  Probable ◦ 18 classified as non-adherent ◦ 3 declined participation ◦ 1 documented Adherent identified as Non- adherent ◦ 1 documented SA Adherent identified as Cured ◦ 1 enrolled - 1 st patient on June 1 st !

13. The prevalence of “Adherent But…” Discrepancies ◦ Medical charts ◦ Patient accounts “The Gap” – what patients say vs. what they do Misclassifications and Biases

14. Challenges for Patients Old Equipment Re-ordering Supplies ◦ Medicare requirements  i.e. Medicare requires repair of machines before replacements or proof that device is unfixable ◦ Incorrect Dictations  i.e. Patient’s office visit states recently acquired new PAP device but patient did not; now must wait for corrected dictation or make another office visit

15. Barriers of Data Collection Devices ◦ Supplies obtained outside GHS ◦ Device not brought to hospital  At home  Family cannot bring in  With manufacturer for repair Patient Historians ◦ Remembering reason for initial sleep study referral ◦ Recalling how often supplies reordered

16. Retrieving PAP Data The Bad News - some devices are too vintage to store data The Good News ◦ Devices that are too old are not seen as frequently ◦ Most devices can download data to a portable memory card ◦ Some new top-of-the-line models can upload to ‘The Cloud’

17. Potentials to Improve Adherence Brightree Connect – enhanced communication & automated re-supply Clinicians available M-F 8:30am-6pm Increased knowledge of Primary Care Physicians Sleep Clinic Referrals Adding a Respiratory Therapist to Genesis West GHME location Moving Silvis GHME site to a more convenient Moline location

18. Medicare Allowable Reimbursement

19. Can’t we all sleep so soundly?