退伍军人健康管理局 TeleSleep 全企业倡议 2017-2020：为我们国家的退伍军人提供睡眠关怀。
Veterans Health Administration TeleSleep Enterprise-Wide Initiative 2017-2020: bringing sleep care to our nation's veterans.
机构信息
Pulmonary, Critical Care, and Sleep Medicine, Veterans Administration (VA) Greater Los Angeles Health Care System, Los Angeles, California.
Department of Medicine, University of California, Los Angeles, Los Angeles, California.
出版信息
J Clin Sleep Med. 2023 May 1;19(5):913-923. doi: 10.5664/jcsm.10488.
STUDY OBJECTIVES
The Veterans Health Administration cares for many veterans with sleep disorders who live in rural areas. The Veterans Health Administration's Office of Rural Health funded the TeleSleep Enterprise-Wide Initiative (EWI) to improve access to sleep care for rural veterans through creation of national telehealth networks.
METHODS
The TeleSleep EWI consists of (1) virtual synchronous care, (2) home sleep apnea testing, and (3) REVAMP (Remote Veterans Apnea Management Platform), a patient- and provider-facing web application that enabled veterans to actively engage with their sleep care and sleep care team. The TeleSleep EWI was designed as a hub-and-spoke model, where larger sites with established sleep centers care for smaller, rural sites with a shortage of providers. Structured formative evaluation for the TeleSleep EWI is supported by the Veterans Health Administration's Quality Enhancement Research Initiative and was critical in assessing outcomes and effectiveness of the program.
RESULTS
The TeleSleep EWI launched with 7 hubs and 34 spokes (2017) and rapidly expanded to 13 hubs and 63 spokes (2020). The TeleSleep EWI resulted in a significant increase in rural veterans accessing sleep care by utilizing home sleep apnea testing to establish a diagnosis of obstructive sleep apnea and virtual care for follow-up. Rates of virtual care utilization were greater in hubs and spokes participating in the TeleSleep EWI compared with non-EWI sleep programs. Additionally, veterans expressed satisfaction with their virtual care TeleSleep experiences.
CONCLUSIONS
The TeleSleep EWI successfully increased sleep care access for rural veterans, promoted adoption of virtual care services, and resulted in high patient satisfaction.
CITATION
Chun VS, Whooley MA, Williams K, et al. Veterans Health Administration TeleSleep Enterprise-Wide Initiative 2017-2020: bringing sleep care to our nation's veterans. . 2023;19(5):913-923.
研究目的
退伍军人健康管理局为许多居住在农村地区的患有睡眠障碍的退伍军人提供服务。退伍军人健康管理局的农村卫生办公室为 TeleSleep 全企业倡议（EWI）提供资金，通过创建国家远程医疗网络，为农村退伍军人改善获得睡眠护理的机会。
方法
TeleSleep EWI 由（1）虚拟同步护理、（2）家庭睡眠呼吸暂停测试和（3）REVAMP（远程退伍军人呼吸暂停管理平台）组成，这是一个面向患者和提供者的网络应用程序，使退伍军人能够积极参与他们的睡眠护理和睡眠护理团队。TeleSleep EWI 被设计为一个中心辐射模型，其中拥有成熟睡眠中心的较大站点为缺乏提供者的较小农村站点提供服务。退伍军人健康管理局的质量提升研究倡议为 TeleSleep EWI 的结构化形成性评估提供支持，这对于评估该计划的结果和效果至关重要。
结果
TeleSleep EWI 于 2017 年推出时拥有 7 个中心和 34 个辐射站点（2017 年），并迅速扩展到 2020 年的 13 个中心和 63 个辐射站点。TeleSleep EWI 通过利用家庭睡眠呼吸暂停测试来建立阻塞性睡眠呼吸暂停的诊断，并为后续治疗提供虚拟护理，使更多农村退伍军人能够获得睡眠护理。与非 EWI 睡眠项目相比，参与 TeleSleep EWI 的中心和辐射站点的虚拟护理利用率更高。此外，退伍军人对他们的虚拟护理 TeleSleep 体验表示满意。
结论
TeleSleep EWI 成功地增加了农村退伍军人的睡眠护理机会，促进了虚拟护理服务的采用，并获得了很高的患者满意度。
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