Use of In-Laboratory Sleep Studies in the Veterans Health Administration and Community Care

• Published in: American journal of respiratory and critical care medicine Vol. 200; no. 6; pp. 779 - 782
• Main Authors: Donovan, Lucas M, Coggeshall, Scott S, Spece, Laura J, Griffith, Matthew F, Palen, Brian N, Parsons, Elizabeth C, Todd-Stenberg, Jeffrey A, Glorioso, Thomas J, Carey, Evan P, Feemster, Laura C, Zeliadt, Steven B, Kirsh, Susan, Au, David H
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.09.2019
• Subjects: Adult; Aged; Body mass index; Clinical medicine; Community Health Services - statistics & numerical data; Confidence intervals; Correspondence; Costs; Demographics; Diabetes; Female; Health care access; Health care policy; Hospital administration; Humans; Hypertension; Laboratories; Male; Medicare; Middle Aged; Patients; Polysomnography - statistics & numerical data; R&D; Research & development; Sleep apnea; Sleep Wake Disorders - diagnosis; United States; United States Department of Veterans Affairs - statistics & numerical data; Veterans; Veterans - statistics & numerical data; Veterans Health - statistics & numerical data; United States; Colorado
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201902-0313LE

The activities were undertaken in support of a VA operational project and did not constitute research, in whole or in part, in compliance with VA Handbook 1058.05. [...]institutional review board approval was not required. Because home tests are appropriate for patients with a moderate–high OSA risk (5), we recorded confounders that have been hypothesized to track with pretest OSA risk and medical complexity: body mass index, age, sex, race, ethnicity, hypertension, diabetes, and Charlson Comorbidity Index in the year before testing (5, 7). VA providers performed 37.7% of studies as home tests, compared with 19.0% in Fee Basis and 4.1% in Choice (Figure 1). Because of lower home testing, every 100 veterans referred to Fee Basis represented $8,831 (95% confidence interval [CI], $8,587–9,076) greater costs than those treated by VA providers, and every 100 veterans referred to Choice represented $15,814 (95% CI, $15,603–16,024) greater costs than those treated by VA providers (Table 1). [...]our average cost model likely underestimates the cost difference between community care and the VA.