EvergreenHealth Sleep Disorders Center, Kirkland, WA.
Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.
Sleep. 2021 Apr 9;44(4). doi: 10.1093/sleep/zsaa243.
Obstructive sleep apnea (OSA) is a highly prevalent yet underdiagnosed disorder affecting US military Veterans. The Remote Veterans Apnea Management Platform (REVAMP) is a web-based OSA management program created to improve access to care. REVAMP was launched within the Veterans Health Administration (VHA) in July 2017, with variable patient recruitment rates (from 0 to 573 patients per site) at the first 10 Veterans Affairs (VA) medical centers (Wave-1 sites). This study aimed to examine the contextual circumstances surrounding the implementation of REVAMP from the provider perspective to inform strategies to increase its uptake at future rollout sites.
A purposive sample of REVAMP site leaders from the Wave-1 sites was recruited with additional staff members being solicited as well. Semi-structured interviews were conducted. Two independent coders reviewed individual transcripts using content analysis to identify emerging themes.
Fifteen individuals from Wave-1 sites were interviewed. Implementation of REVAMP was facilitated by the presence of leadership support, staff, and time dedicated to REVAMP, and perceived usefulness of REVAMP by staff as well as positive feedback from the Veterans using REVAMP. The difficulty of supporting Veteran creation of login credentials to the program and integrating REVAMP into the existing workflow were major barriers to its implementation.
Improving leadership engagement, simplifying the enrollment process, and enhancing the medical staff experience through shared best practice alerts were identified as actions needed to improve the penetration of REVAMP at future rollout sites.
阻塞性睡眠呼吸暂停（OSA）是一种在美国退伍军人中普遍存在但诊断不足的疾病。远程退伍军人睡眠呼吸暂停管理平台（REVAMP）是一个基于网络的 OSA 管理程序，旨在改善获得治疗的机会。REVAMP 于 2017 年 7 月在退伍军人健康管理局（VHA）推出，在前 10 个退伍军人事务部（VA）医疗中心（Wave-1 站点）的患者招募率（每个站点从 0 到 573 名患者不等）有所不同。本研究旨在从提供者的角度检查实施 REVAMP 的背景情况，为未来推出的网站增加其使用率提供信息。
从 Wave-1 站点中招募了有针对性的 REVAMP 站点负责人样本，并征求了其他工作人员的意见。进行了半结构化访谈。两名独立的编码员使用内容分析审查了个人记录，以确定新出现的主题。
从 Wave-1 站点采访了 15 人。领导支持、工作人员和专门用于 REVAMP 的时间的存在，以及工作人员对 REVAMP 的感知有用性以及使用 REVAMP 的退伍军人的积极反馈，促进了 REVAMP 的实施。支持退伍军人创建登录凭证程序和将 REVAMP 整合到现有工作流程的困难是其实施的主要障碍。
提高领导参与度、简化注册流程以及通过共享最佳实践警报提高医疗人员的体验，被确定为改善未来推出站点的 REVAMP 渗透率所需的措施。
