SHORT-TERM IMPACT OF AN INTEGRATED MULTIDISCIPLINARY PATIENT-CENTERED COORDINATED CARE TREATMENT IN OSA

Abstract

SESSION TITLE: Sleep Disorders SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 PM - 02:00 PM PURPOSE: Obstructive sleep apnea (OSA) is a common chronic condition with public health consequences which is characterized by breathing cessation and impaired oxygenation during sleep resulting in sleep fragmentation and impaired daytime activities; and is associated with cardio-metabolic diseases and mortality. Its treatment is multi-disciplinary. However, its current mode of care delivery is often fragmented with various disciplines operating in isolation. We aim to determine the impact of a novel integrated outpatient OSA care model using a care pathway which incorporates evidence-based management guidelines involving a multi-disciplinary team of healthcare professionals. We hypothesize that the integrated care model will be associated with improved outcomes as compared to current routine care. METHODS: This is a prospective randomized controlled trial comparing a new integrated model of care for OSA with routine practice in patient-reported outcomes, CPAP adherence and waiting time to receiving definitive OSA treatment. In the integrated care model, providers from various key disciplines (sleep medicine, otolaryngology and dentistry) convene to assess the patient and develop the best preferred treatment plan based on shared decision making with the patient using a common care pathway in a multidisciplinary clinic; compared to the conventional model where patients are cross-referred and seen by each discipline in isolation. RESULTS: The trial enrolled 220 patients. About three-quarters were males (73%) and were Chinese (72%). Mean age was 47.6 ± 14.4 years and mean body mass index (BMI) was 31.1 ± 7.4 kgm-2. Mean Epworth Sleepiness Scale (ESS) and Functional Outcome Sleep Questionnaire (FOSQ) score were 11.2 ± 4.9 and 15.4 ± 4.0 respectively. Median AHI was 36.6 ± 39.7 h-1 and 82% had moderate to severe OSA. Vast majority (84%) opted and received CPAP treatment. There was no difference in the proportions of patients receiving CPAP in both arms (62% vs. 57%, p=0.83). At 1 month post treatment, there was an improvement in FOSQ scores in the integrated care arm compared to the routine care arm (-1.5 ± 5.1 vs. -0.60 ± 4.7, p=0.01). However, there was no significant change in the ESS scales (-2.0 ± 4 vs. -0.5 ± 3.1, p=0.32) and difference in the median hours of CPAP use per used day between the 2 groups (4.65 ± 2.58 vs. 4.30 ± 1.60, p=0.82). The average waiting time between undergoing sleep study procedure and receiving definitive OSA treatment in the integrated care arm was significantly lower than in the routine care arm (13.1 vs 27.3 days, p=0.03). CONCLUSIONS: At short term follow-up, an integrated multidisciplinary OSA management care model in the outpatient clinic achieved better sleep functional outcomes and shorter clinic appointment waiting time than routine care among OSA patients. CLINICAL IMPLICATIONS: This may pave way for a new model of care delivery in the outpatient clinic setting for OSA. DISCLOSURES: No relevant relationships by Munirah Abd Gani, source=Web Response No relevant relationships by Shaffinaz Abd Rahman, source=Web Response No relevant relationships by Ai-Ping Chua, source=Web Response No relevant relationships by WENJIA GUO, source=Web Response no disclosure on file for Tun-Oo Han; no disclosure on file for yin maw hsann; no disclosure on file for Esther Hui–Ting Koh; No relevant relationships by Maria Victoria Jane Parot, source=Web Response No relevant relationships by Sue Rene Soon, source=Web Response No relevant relationships by Sridhar Venkateswaran, source=Web Response No relevant relationships by Adrian Yap, source=Web Response