Sleep Center, Division of Pulmonary and Sleep Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Pediatr Pulmonol. 2022 Nov;57(11):2629-2637. doi: 10.1002/ppul.26075. Epub 2022 Jul 22.
Successful treatment of pediatric obstructive sleep apnea syndrome (OSAS) with continuous positive airway pressure (CPAP) is challenging due to behavioral, technical, medical, and systems factors. We undertook a quality improvement (QI) initiative involving physicians, nurses, psychologists, and respiratory therapists to improve CPAP outpatient care and processes. We aimed to: (1) increase the proportion of patients with a follow-up visit within 4 months of initiation of CPAP, (2) reduce the median time to first follow-up visit to under 4 months, and (3) increase the proportion of patients obtaining a post-initiation polysomnogram within 1 year to >50%. We also explored healthcare utilization (HCU) in a subsample of patients. Interventions focused on developing a tracking system and standardizing interdisciplinary clinical care. The proportion of patients returning to clinic within 4 months improved from 38.2% to 65.5% and median time to first follow-up visit improved from 133 to 56 days. The percentage of patients who returned for a post-initiation polysomnogram within 1 year was 71.1%. Subsample analyses showed significant reductions in the length of stay for emergency department visits from pre-CPAP initiation (Mdn = 3.00 h; interquartile range [IQR] = 7.00) to post-initiation (Mdn = 2.00 h, IQR = 5.00). The length of hospitalizations was also significantly shorter from pre (Mdn = 48.00 h, IQR = 243.00) to post-CPAP initiation (Mdn = 0.00 h, IQR = 73.00). A standardized, tracked approach to interdisciplinary outpatient CPAP care can improve follow-up care and potentially HCU.
小儿阻塞性睡眠呼吸暂停综合征（OSAS）患者经持续气道正压通气（CPAP）治疗的效果受行为、技术、医疗和系统等多种因素的影响。我们开展了一项质量改进（QI）计划，涉及医生、护士、心理学家和呼吸治疗师，以改善 CPAP 门诊护理和流程。我们的目标是：（1）增加 CPAP 起始后 4 个月内进行随访的患者比例；（2）将首次随访的中位数时间缩短至 4 个月以下；（3）将在 1 年内获得 CPAP 起始后多导睡眠图的患者比例提高至 >50%。我们还在患者的亚样本中探索了医疗保健利用情况（HCU）。干预措施侧重于开发跟踪系统和标准化的跨学科临床护理。在 4 个月内返回诊所的患者比例从 38.2%增加到 65.5%，首次随访的中位数时间从 133 天缩短至 56 天。在 1 年内返回进行 CPAP 起始后多导睡眠图检查的患者比例为 71.1%。亚样本分析显示，CPAP 起始前急诊就诊的住院时间（中位数 = 3.00 小时；四分位距 [IQR] = 7.00）较 CPAP 起始后显著减少（中位数 = 2.00 小时，IQR = 5.00）。CPAP 起始前住院时间（中位数 = 48.00 小时，IQR = 243.00）也明显短于 CPAP 起始后（中位数 = 0.00 小时，IQR = 73.00）。对跨学科门诊 CPAP 护理采用标准化、跟踪式方法可以改善随访护理，并可能减少 HCU。
