Patient Engagement and Provider Effectiveness of a Novel Sleep Telehealth Platform and Remote Monitoring Assessment in the US Military: Pilot Study Providing Evidence-Based Sleep Treatment Recommendations

BACKGROUND

Sleep problems are common and costly in the US military. Yet, within the military health system, there is a gross shortage of trained specialist providers to address sleep problems. As a result, demand for sleep medicine care far exceeds the available supply. Telehealth including telemedicine, mobile health, and wearables represents promising approaches to increase access to high-quality and cost-effective care.

OBJECTIVE

The purpose of this study was to evaluate patient engagement and provider perceived effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military. The platform includes a desktop web portal, native mobile app, and integrated wearable sensors (ie, a commercial off-the-shelf sleep tracker [Fitbit]). The goal of the remote monitoring assessment was to provide evidence-based sleep treatment recommendations to patients and providers.

METHODS

Patients with sleep problems were recruited from the Internal Medicine clinic at Walter Reed National Military Medical Center. Patients completed intensive remote monitoring assessments over 10 days (including a baseline intake questionnaire, daily sleep diaries, and 2 daily symptom surveys), and wore a Fitbit sleep tracker. Following the remote monitoring period, patients received assessment results and personalized sleep education in the mobile app. In parallel, providers received a provisional patient assessment report in an editable electronic document format. Patient engagement was assessed via behavioral adherence metrics that were determined a priori. Patients also completed a brief survey regarding ease of completion. Provider effectiveness was assessed via an anonymous survey.

RESULTS

In total, 35 patients with sleep problems participated in the study. There were no dropouts. Results indicated a high level of engagement with the sleep telehealth platform, with all participants having completed the baseline remote assessment, reviewed their personalized sleep assessment report, and completed the satisfaction survey. Patients completed 95.1% of sleep diaries and 95.3% of symptom surveys over 10 days. Patients reported high levels of satisfaction with most aspects of the remote monitoring assessment. In total, 24 primary care providers also participated and completed the anonymous survey. The results indicate high levels of perceived effectiveness and identified important potential benefits from adopting a sleep telehealth approach throughout the US military health care system.

CONCLUSIONS

Military patients with sleep problems and military primary care providers demonstrated high levels of engagement and satisfaction with a novel sleep telehealth platform and remote monitoring assessment. Sleep telehealth approaches represent a potential pathway to increase access to evidence-based sleep medicine care in the US military. Further evaluation is warranted.

0375 Effectiveness of an intelligent sleep management system in the US military: Preliminary results

Introduction

There are well-recognized barriers limiting access to evidence-based sleep interventions in the military. Given the large number of patients seeking treatment and the shortage of trained specialist providers, demand greatly exceeds available supply. As part of a larger implementation effort, the purpose of this study was to evaluate health provider ratings of the effectiveness and usability of a novel sleep telehealth assessment at a busy military treatment facility.

Methods

Health providers were recruited from the Internal Medicine and Sleep Medicine clinics at Walter Reed National Military Medical Center. Effectiveness was defined a priori based on the established Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) implementation science framework. Providers from participating clinics completed a questionnaire that measured specific aspects of effectiveness: perceived satisfaction, usability, improvement, credibility, risks, benefits, acceptability and overall satisfaction with a sleep assessment report.

Results

Providers (n=16) were surveyed regarding perceived satisfaction, usability, improvement, credibility, risks, benefits, and acceptability of the sleep assessment report were rated favorably, with each domain being rated with a positive or very positive response by more than 75% of providers. All providers viewed the usability of the report favorably and all but one provider had a positive view on the report improving their documentation of sleep problems.

Conclusion

Health care providers at our hospital rated a novel sleep telehealth assessment as highly effective across established key domains of implementation science. Providers were highly satisfied with the content, usability, and credibility of the report, and felt this intervention would improve their documentation. Research is ongoing to further evaluate the implementation of the system.

Support (If Any)

This research was supported by an investigator-initiated research award from the Department of Defense (via the Medical Technology Enterprise Consortium) to the University of Maryland, Baltimore (PI: EMW).

Maintenance of an adequate dental hygiene education system

Decreases in faculty size and declining enrollments in dental hygiene programs are, in part, reflections of the economic difficulties faced by educational institutions with which the programs are affiliated. Administrative decisions about the future of dental hygiene programs are often based on inadequate information about employment trends and about the importance of the dental hygienist in dental practices. Although the relationship between demand for dental care and the availability of personnel to meet that demand is now unclear, studies indicate that demand for dental hygiene services will remain high in the 1980s. The impact of dental hygienists on dental health care delivery in any given region must be studied carefully when decisions are made about dental hygiene programs, because it is very expensive to replace discontinued programs or those disabled by large budget cuts.