Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study

Shefali Kumar, Emma Rudie, Cynthia Dorsey, Amy Blase, Adam V Benjafield, Shannon S Sullivan, Shefali Kumar, Emma Rudie, Cynthia Dorsey, Amy Blase, Adam V Benjafield, Shannon S Sullivan

Abstract

Background: Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway.

Objective: This prospective, single-arm, multistate feasibility pilot study aimed to understand the journey in a nonreferred sample of participants through the fully remote OSA screening and diagnostic and treatment pathway, using the Primasun Sleep Apnea Program (formally, Verily Sleep Apnea Program).

Methods: Participants were recruited online from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician who could order a home sleep apnea test (HSAT) to be delivered to the participant's home. The results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. The participants who were diagnosed with OSA during the study and prescribed a positive airway pressure (PAP) device were instructed to download an app that provides educational and support-related content and access to personalized coaching support during the study's 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program.

Results: For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 (SD 2.6) days and median 7.1 days (IQR 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 (SD 9.6) days and median 11.7 days (IQR 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from the first televisit appointment to receiving an OSA diagnosis was 21.4 (SD 9.6) days and 18.9 days (IQR 9.2), respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 (SD 9.3) days and median 6.0 days (IQR 4.0) from OSA diagnosis to PAP therapy initiation.

Conclusions: These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost. The program's ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic, as the United States shifted to remote care models and may sustain this direction. The potential economic and clinical impact of the program's short and efficient journey time and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and adherence.

Trial registration: ClinicalTrials.gov NCT04599803; https://ichgcp.net/clinical-trials-registry/NCT04599803.

Keywords: OSA; OSA diagnosis; diagnostic; eHealth; feasibility; obstructive sleep apnea; patient-centered; remote care; sleep apnea; treatment pathway; underdiagnosed; virtual care.

Conflict of interest statement

Conflicts of Interest: Primasun makes and owns the PSAP (Primasun Sleep Apnea Program) examined in this study. Primasun is a joint venture between ResMed and Verily Life Sciences. SK, ER, CD, and SSS work for Verily Life Sciences. AB and AVB work for ResMed.

©Shefali Kumar, Emma Rudie, Cynthia Dorsey, Amy Blase, Adam V Benjafield, Shannon S Sullivan. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.01.2022.

Figures

Figure 1
Figure 1
Participant flow through the pilot study; HSAT: home sleep apnea test; OSA: obstructive sleep apnea; PAP: positive airway pressure.
Figure 2
Figure 2
Outlier detection for key patient journey time metrics. HSAT: home sleep apnea test; OSA: obstructive sleep apnea.
Figure 3
Figure 3
Key patient journey time metrics. HSAT: home sleep apnea test; PAP: positive airway pressure.
Figure 4
Figure 4
Median total journey times in obstructive sleep apnea (from screening to onboarding to positive airway pressure). HSAT: home sleep apnea test; PSAP: Primasun Sleep Apnea Program; PAP: positive airway pressure.

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