Geographic disparities in performance of pediatric polysomnography to diagnose obstructive sleep apnea in a universal access health care system

2021 ◽  
pp. 110803
Author(s):  
D. Radhakrishnan ◽  
B. Knight ◽  
P. Gozdyra ◽  
S.L. Katz ◽  
I.B. Maclusky ◽  
...  
Keyword(s):  
Health Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Health Care System ◽  
Universal Access ◽  
Geographic Disparities ◽  
Obstructive Sleep ◽  
Care System

scholarly journals Major Care Gaps in Asthma, Sleep and Chronic Obstructive Pulmonary Disease: A Road Map for Knowledge Translation

2013 ◽  
Vol 20 (4) ◽  
pp. 265-269 ◽  
Author(s):  
Louis-Philippe Boulet ◽  
Jean Bourbeau ◽  
Robert Skomro ◽  
Samir Gupta
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pulmonary Disease ◽  
Health Care System ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Obstructive Sleep ◽  
Care Gaps

Large gaps between best evidence-based care and actual clinical practice exist in respiratory medicine, and carry a significant health burden. The authors reviewed two key care gaps in each of asthma, chronic obstructive pulmonary disease and obstructive sleep apnea. Using the ‘Knowledge-to-Action Framework’, the nature of each gap, its magnitude, the barriers that cause and perpetuate it, and past and future strategies that might address the problem were considered. In asthma: disease control is ascertained inadequately, leading to a prevalence of poor asthma control of approximately 50%; and asthma action plans, a key component of asthma management, are provided by only 22% of physicians. In obstructive sleep apnea: disease is under-recognized, with sleep histories ascertained in only 10% of patients; and Canadian polysomnography wait times remain longer than recommended, leading to unnecessary morbidity and societal cost. In chronic obstructive pulmonary disease: a large proportion of patients seen in primary care remain undiagnosed, mainly due to underuse of spirometry; and <10% of patients are referred for pulmonary rehabilitation, despite strong evidence demonstrating its cost effectiveness. Given the prevalence of these chronic conditions and the size and nature of these gaps, the latter exact an important toll on patients, the health care system and society. In turn, complex barriers at the patient, provider and health care system levels contribute to each gap. There have been few previous attempts to bridge these gaps. Innovative and multifaceted implementation approaches are needed and have the potential to make a large impact on Canadian respiratory health.

Cost-effectiveness of continuous positive airway pressure therapy for obstructive sleep apnea: health care system and societal perspectives

SLEEP ◽  
2019 ◽  
Vol 42 (12) ◽  
Author(s):  
Jared Streatfeild ◽  
David Hillman ◽  
Robert Adams ◽  
Scott Mitchell ◽  
Lynne Pezzullo
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health System ◽  
Health Care System ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cpap Therapy ◽  
System Perspective ◽  
Obstructive Sleep ◽  
Care System

Abstract Study Objectives To determine cost-effectiveness of continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) in Australia for 2017–2018 to facilitate public health decision-making. Methods Analysis was undertaken of direct per-person costs of CPAP therapy (according to 5-year care pathways), health system and other costs of OSA and its comorbidities averted by CPAP treatment (5-year adherence rate 56.7%) and incremental benefit of therapy (in terms of disability-adjusted life years [DALYs] averted) to determine cost-effectiveness of CPAP. This was expressed as the incremental cost-effectiveness ratio (= dollars per DALY averted). Direct costs of CPAP were estimated from government reimbursements for services and advertised equipment costs. Costs averted were calculated from both the health care system perspective (health system costs only) and societal perspective (health system plus other financial costs including informal care, productivity losses, nonmedical accident costs, deadweight taxation and welfare losses). These estimates of costs (expressed in US dollars) and DALYs averted were based on our recent analyses of costs of untreated OSA. Results From the health care system perspective, estimated cost of CPAP therapy to treat OSA was $12 495 per DALY averted while from a societal perspective the effect was dominant (−$10 688 per DALY averted) meaning it costs more not to treat the problem than to treat it. Conclusions These estimates suggest substantial community investment in measures to more systematically identify and treat OSA is justified. Apart from potential health and well-being benefits, it is financially prudent to do so.

scholarly journals 0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A280-A281
Author(s):  
S E Neill ◽  
R Majid
Keyword(s):  
Health Care ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
The United States ◽  
Initial Study ◽  
Diagnostic Value ◽  
Obstructive Sleep ◽  
Medicare Patients ◽  
Care Costs

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

Markets in Health Care: The Case of Renal Transplantation

2007 ◽  
Vol 35 (2) ◽  
pp. 249-255 ◽  
Author(s):  
Troyen Brennan
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Organ Procurement ◽  
Universal Access ◽  
Developed Countries ◽  
American Health Care System ◽  
Outcomes Of Care ◽  
Recent Developments ◽  
State Programs ◽  
Care System

Recent developments in organ procurement have revived the much-debated role of markets in our health care system. The unique American health care system, with its presumption of universality alongside private health insurance and relatively limited federal and state programs, is in many ways consumer-driven today. We certainly tolerate more broad disparities in availability of care and in outcomes of care largely based on socioeconomic status than do many other developed countries, where notions of universal access are supported by broader public financing.

scholarly journals Defragmenting the Health Care System in Mexico: Universal Access For Obstetric Emergencies

2020 ◽  
Vol 4 (1) ◽  
pp. 80-92
Author(s):  
María G. Ramírez-Rojas ◽  
María G. Freyermuth-Enciso ◽  
María B. Duarte-Gómez
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Emergency Services ◽  
Universal Access ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Medical Emergency ◽  
Cross Sectional ◽  
Obstetric Emergencies ◽  
Care System

Background and Objectives: This article aims to analyze how the needs of Mexican women requiring emergency obstetric care (EmOC) can be fully met through initiatives such as the General Agreement on Inter-Institutional Collaboration for Emergency Obstetric Care (the Agreement). We compared EmOCaccredited facilities operating under the Agreement with facilities outside the Agreement which, although not accredited, provide their affiliates with EmOC services. Methods: Based on an observational, descriptive, cross-sectional design, we analyzed the Agreement interinstitutional strategy within four different scenarios in order to verify whether Mexico was in compliance with United Nations (UN) recommendations on EmOC availability: five facilities, with at least one offering comprehensive services, per 500,000 inhabitants. Results: Taking into account all facilities in the Mexican health care system, we found that Mexico offered 75% of the required facilities and was therefore 25% short of compliance. According to data on hospital discharges, 734 438 cases of obstetric emergencies (OEs) were registered in Mexico in 2013, the vast majority of which were assisted by facilities unaccredited for that function. Meanwhile, the 466 accredited facilities, all operating under the Agreement, served a negligible proportion (0.07%) of these patients. Conclusion and Implications For Translation: The Agreement would undoubtedly reach its potential as a vehicle for universal EmOC coverage were its field of action not restricted to such a small number of services for women. The Mexican health care system is faced with the double challenge of increasing institutional coverage and upgrading installed EmOC infrastructure. Key words: • Medical emergency services • Mexico, Medical assistance • Hospitalization • Health regulation • Agreements.   Copyright © 2020 Ramírez-Rojas et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial (CC BY-NC 4.0) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work which is published in this journal is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.

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