Obstructive sleep apnea (OSA) affects approximately 25 million Americans. There are many options for treating the disorder, the most common of which is continuous positive airwave pressure (CPAP) therapy. As most providers are aware, however, getting patients to comply with CPAP therapy can be difficult. Masks can be claustrophobic and uncomfortable, hoses can get tangled and insurance can be a maze for patients to navigate, all leading to frustration with the process of acclimation to a new device.
In March 2013, ResMed set out to see if their new U-Sleep platform for CPAP users could change the pattern of noncompliance. ResMed partnered with Sleep Data Holdings, LLC, a DME provider in Southern California; 122 patients were evaluated in the final analysis. The study’s question was simple: Do patients fare better with standard clinician care, or can a cloud-connected CPAP device (with clinician intervention when necessary) provide the same level of care, and did patients achieve a higher level of compliance?
For the ResMed sleep study, published in Sleep and Breathing in January, newly diagnosed OSA patients were divided into two groups and given connected CPAP devices, as well as education about their OSA. One group of patients received a standard of care (SOC) from respiratory therapists, being contacted by phone on days 1, 7, 14, 30 and 90. A wireless modem in the device tracked compliance, and issues that turned from viewing the data were addressed during phone calls or return visits to the respiratory clinic.
The second group of OSA patients received a cloud-connected CPAP device and education about the U-Sleep platform. The clinicians conducting the study set up online records in the U-Sleep software to track patient therapy progress. Follow-up with U-Sleep patients was automated based on a set of rules applied at the issue of the device, or when the clinician thought intervention was necessary. All patients in the study received a follow-up phone call at 90 days to gauge how well the program met their expectations.
Overall, patients in the SOC group received more coaching and more time was spent with these patients achieving and maintaining compliance. There was a 59 percent decrease in HME coaching labor for the U-Sleep group. In addition to the decreased coaching requirements, the study found that those patients using the U-Sleep platform with their CPAP devices had a 10 percent increase in compliance. (The study was designed to detect and assign significance to 20 percent differences.)
“The standard of care model used in this study was pretty thorough,” says Amy Cook, director of product marketing for healthcare informatics at ResMed. “The 10 percent bump in compliance (for the U-Sleep group) was exciting for us.” As those conducting the study pointed out, both groups of patients achieved excellent compliance rates at 73 percent for the SOC group and 83 percent for the U-Sleep group.
The U-Sleep platform works for patients by providing them with feedback on their progress. Nighttime data is uploaded via a cloud system—in this case the AirView platform. The clinician is able to view the data on U-Sleep’s Action View screen and sort out those patients most in need of intervention. Patients who had a good night can be sent an encouraging text message to continue with their therapy as usual. A patient with a severe mask leak or high apnea hypopnea index (AHI), however, may prompt a phone call to address the issue. And, patients puttering along with compliance, using the device one night but not using it the next, may simply need a reminder email to keep trying for better results. Patients can customize their contact options, opting out of text alerts and choosing to get only emails and phone calls, or any combination of alerts that works best for their needs. Action View helps providers track these preferences and automates the process, while the AirView cloud seamlessly integrates with U-Sleep’s management software.
“There are various definitions of compliance from a provider’s perspective,” says Cook. The U-Sleep platform allows providers to manage by exception. The rules set up in Action View allows patients to be sorted into groups for management and follow-up. Compliant patients in need of low-touch, ongoing therapy management can be separated from those with issues such as high mask leak. “You can set Medicare’s compliance requirements aside and focus on your patient,” with Action View, says Cook.
Casey Toomajian is the CEO of Hometown Healthcare in Watervliet, New York. As an HME provider in the sleep and breathing care market, keeping track of patient compliance is a big part of his team’s day. Hometown Healthcare introduced the U-Sleep platform to the care model in December 2015. Toomajian estimates that his team had an 80 percent compliance rate under the former standard of care model, but he was searching for a method to scale things up and achieve a higher rate. He was also searching for a more efficient communication method with patients in order to keep his team focused and provide the best possible care.
The U-Sleep platform reduced the workload for the Hometown team by 50 percent. Toomajian says, “We went from a push mower with our previous system to a zero-turn mower,” with U-Sleep, in terms of the ability to track and monitor patient progress. The Action View system, “serves up on a silver platter those patients who are struggling and really need help,” allowing the Hometown team of therapists to respond quickly to the patients most in need, while setting aside the patients who need less attention for later in the day.
“The technology reduced the number of touchpoints per patient 75 percent—from 1,000 to 240,” says Toomajian. Now, the Hometown team isn’t wasting time inputting data that the connected CPAP device has already uploaded.
One concern of the Sleep and Breathing study regarding labor requirements for telehealth patients was the time spent on the phone when a patient did have an issue that needed to be addressed, as indicated by the connected CPAP device. Phone calls with patients in the study lasted an average of nine minutes to address problems and concerns. But, the study’s authors noted, this was an arbitrary time assigned to the calls and Sleep Data did not actually measure call time with telehealth patients. Toomajian has noted his call time with patients has increased when a problem arises, but says, “We’re spending time (on the phone) with people who really need it. Overall, there has been a significant reduction in our labor input.” Toomajian added that on the old model of care, his patients would tell him they were doing well during a check-in call, but could be struggling and he had no real way to verify that information. With U-Sleep, the information is at his fingertips.
For Toomajian, the U-Sleep platform has an element of support he has not seen before. “I forget alerts are going out to my patients—the system is so automated—but there is a human element because my team is reaching out to patients in trouble. I have peace of mind that none of my patients are getting left behind.”
Toomajian has not completed his evaluation of the U-Sleep platform and connected CPAP devices, such as the ResMed Air10. What he enjoys most about the system is seeing the difference in insurance companies’ definition of compliance and how CPAP device users can have a long-term commitment to therapy, even if they struggle in the short term. “The system is really set up for patient-centered care, to drive that long-term commitment to therapy and care.”
Cloud-connected CPAP technology provides many benefits for patients and providers alike. The ResMed U-Sleep platform provides the connectivity and functionality providers need to keep their businesses running smoothly every day. The platform’s integrated technology gives providers the opportunity to reach patients most in need of care while maintaining a connection with patients reaching their compliance goals. The U-Sleep platform is a comprehensive solution for HME providers looking for simple methods to reduce labor commitments while maintaining a high level of patient care.