According to the American Sleep Association, sleep apnea effects more than 12 million people in the U.S. and has been linked to the development and management of a number of chronic conditions, including diabetes, cardiovascular disease, obesity, and depression. It often goes undiagnosed; as doctors usually can't detect the condition during routine office visits, while there isn’t a single blood test can help diagnose the condition.
As healthcare providers around the country continue to work towards attesting to meaningful use, proactive management of chronic disease is crucial. Enter the Greenville, S.C.-based MedBridge Healthcare, which offers home respiratory care through its wholly-owned subsidiary, MedBridge Home Medical Services, a provider of respiratory equipment and services. MedBridge currently operate approximately 110 labs throughout the Southeast and Midwest, with 10 locations that dispense continuous positive airway pressure therapy (CPAP) devices, which help a person who has obstructive sleep apnea (OSA) breathe easier during sleep. A CPAP machine increases air pressure in your throat so that your airway doesn't collapse when you breathe in, according to WebMD.
MedBridge currently does approximately 30,000 sleep studies a year and has thousands of patients it sets up each year on CPAP devices, says Matt Mellott, president of MedBridge. Up until a few years ago, says Mellott, the typical way to monitor CPAP patients was to ask them to mail back a card they provided. “So you had to call the patient to get the card back and then you might have a 30-40 day period until you get it back to see if they have been using [the device], and guess what, they haven’t been using it for weeks. That was inefficient, and it was laborious to get their data,” Mellott says. Certainly, as the number of people using CPAP therapy to treat sleep apnea increases, the ability to efficiently and effectively monitor and manage CPAP therapy becomes a critical aspect of healthcare.
In 2012, ResMed, a San Diego, Calif.-based global manufacturer of products for the treatment of sleep disorders, acquired U-Sleep, a cloud platform that provides doctors and patients with easier ways to look at their sleep apnea treatment data. The data is looked at from an analytical perspective on any computer or mobile device, empowering patients to take control of their care.
“Going to one place centrally where data is brought together and you can manage your patients makes a world of difference,” says Mellott, whose organization has been using U-Sleep for about six months. Without a solution such as U-Sleep, he continues, organizations might be using software on local desktops. So for a company such as MedBridge, Mellott couldn’t easily see how branch A is doing on compliance and branch B on something else, he says. “You couldn’t determine issues with setups or follow-ups, so the software has been great from a management perspective to hold our branches accountable.”
And the solution also brings with it a variety of patient engagement tools, Mellott says. “We set up rules within the software, where let’s say the patient doesn’t use the device for three nights in a row, he or she gets a text alert or an email alert. That will correct the behavior, where in the past we were making phone calls to do that. So now we can manage thousands of patients with a small group of people because we are managing by exception. And the patients are self-correcting.”
Mellott says MedBridge just launched the U-Sleep mobile app in May, so patients are now starting to see their usage. Before that, patients got texts or emails when they weren’t using the device enough, and if they didn’t respond, MedBridge would call. Once patients are registered in U-Sleep and have therapy rules assigned to them, sleep professionals and employers will be notified when a patient has either failed or met a rule. Individuals responsible for monitoring large patient populations can receive a single notification per day prompting them to login and view patients that are struggling or doing well with their therapy. “Now they can see their own usage on this app,” explains Mellott. “We can contact them with praise too, rather than just problems.”
The content, type and frequency of notifications can be customized at the time of patient setup and they are available via automated phone call, text and/or email. Notifications can also be sent to clinicians, internal staff or other trusted parties so that they can take an active role in the patient's therapy, according to officials of ResMed, which recently released the outcome of a study that shows significant, measurable efficiency gains when using the automated messaging capabilities of its U-Sleep solution.
The study, which was presented in May at the American Thoracic Society (ATS) 2014 International Conference in San Diego, revealed a 59-percent reduction in labor associated with intervening with and coaching patients on CPAP therapy when using U-Sleep. The goal of the study, ResMed officials, say, was to compare the effectiveness and coaching labor requirements of a web-based, automated messaging (via U-Sleep) with standard-of-care CPAP adherence coaching, and measure the coaching labor necessary to achieve Medicare-defined adherence.
In order to evaluate the effect of automated messaging on coaching labor and patient adherence, researchers conducted a multi-center, prospective trial of patients newly diagnosed with OSA. A total of 122 patients completed the three-month study follow-up, with 58 in the U-Sleep group and 64 in the standard-of-care group. All patients were set up on a CPAP device with heated humidification and a ResMed wireless modem, and both groups received identical CPAP education and orientation.
The U-Sleep arm received an automated series of text messages and/or emails triggered by one of five situations that indicated non-compliance, such as “no CPAP data for two consecutive days” or “CPAP usage of less than four hours for three consecutive nights.” In contrast, the standard-of-care arm received scheduled telephone calls on days one, seven, 14, and 30.
In addition to a 59 percent reduction in labor, there was an observed difference of approximately 10 percent in Medicare-defined adherence for the U-Sleep group (83 vs. 73 percent). Medicare-defined adherence is the documented use of CPAP therapy for at least four hours per night for 70 percent or more nights during a consecutive 30-day period within the first 90 days of therapy.
“Being an organization that has patients with somewhat big conditions, such as congestive heart failure and diabetes, it is critical to treat OSA for OSA but also for general improvement,” says Mellott. “Our goal is to improve compliance as far as we go, and U-Sleep allows us to do that. All of our patients are on modem devices, so the data is feeding into U-Sleep. There is a need to monitor long term, not just to get through billing, or one or two years out. We’re looking to foster long-term care.”