Limitations of this study included the relatively small sample size of 150 patients who were studied, and limitation of the study to a single internal medicine practice. Between time 1 and time 2, the practice underwent changes in office structure, which involved moving to a direct primary care practice that includes a fee for service. Because of the changes in the practice, a new EMR was implemented, and therefore BMI data were unable to be collected at time 3 for all patients.
Implications for Practice
The implications of this project are noteworthy. The findings indicate that a simple intervention involving adding the ESS to the EMR can identify patients with OSA who would have otherwise been undiagnosed; this could lead to better patient outcomes by diagnosing and treating patients with OSA before adverse effects occur. After patients are flagged as high risk by the ESS tool (a score of ≥10), the clinician can then refer the patient for a sleep study, on the basis of which continuous positive airway pressure therapy may be initiated. According to the project findings, there exists the potential for an entirely different group of patients to be identified at risk for OSA. This project could be expanded to other offices, as well as to the hospital setting.
Recommendations for future research are to not simply add the ESS to the EMR, but to create a hard stop that requires providers to screen every patient. By implementing the ESS in the EMR with a hard-stop feature, there is a built-in system for sustainability of routine screening. In time 2, the ESS was available to the provider in the EMR; however, no ESS data were obtained or documented. Therefore, it is recommended that the ESS be used on every patient seen in the office, whether reporting symptoms of sleep-related disorders or asymptomatic.
OSA is a significant health issue that often goes undiagnosed. This project evaluated the use of screening all patients in an internal medicine office, finding that screening resulted in a 20% increase in detection of patients at high risk for OSA, as indicated by an ESS score of 10 or more. This finding is significant in that more widespread screening can result in earlier diagnosis and referral for a sleep study and potentially the addition of continuous positive airway pressure therapy. The literature supports screening as an effective tool for diagnosis of OSA. This is important, as undiagnosed OSA is associated with comorbidities such as cardiovascular disease, stroke, diabetes, and depression.3,6,11,12 Clinicians are encouraged to adopt ESS screening in their practice, and to perform screening on every patient, even those who do not report symptoms suspicious of OSA.
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