Approximately 30% of UCSF Sleep Clinic patients reside outside a 5-10 mile radius, and many face transportation barriers that prevent them from accessing in-lab sleep studies or pick up at-home devices and drop them back off the next day. Additionally, patients with advanced illnesses often lack the necessary support to attend in-person studies or appointments to pick up studies. Currently, UCSF Sleep Clinic does not have a system to mail home sleep apnea testing devices. This project proposes a partnership with Itamar Medical to implement a program that mails disposable WatchPAT devices directly to patients, enabling timely diagnosis and treatment for those in rural areas and with mobility challenges. This initiative will improve access, enhance equity, and streamline operational efficiency.

• Katherine Malcolm, Assistant Professor of Medicine, Pulmonary, Critical Care and Sleep Medicine Department
• Jolie Chang, Professor of Otolaryngology, Head and Neck Surgery, Chief of the Division of Sleep Surgery and General Otolaryngology

PROBLEM:
Many UCSF Sleep Clinic patients travel long distances for care, with at least 30% residing outside a 5-10 mile radius. Transportation barriers, lack of caregiver support, and advanced illness prevent some from completing in-lab sleep studies, delaying diagnosis and treatment. This gap disproportionately affects rural and underserved patients, leading to increased morbidity and healthcare costs due to undiagnosed and untreated sleep apnea. Current financial and operational constraints prevent UCSF from mailing home sleep studies, limiting care access. Addressing this issue now aligns with UCSF’s commitment to health equity and improves patient outcomes by facilitating timely diagnoses.

TARGET:
Our SMARTIE goal is to:

• Implement a mailed WatchPAT program within six months.
• Increase access to home sleep studies for patients in rural areas or with mobility challenges by 50% in the first year.
• Reduce no-show rates for sleep studies by at least 20%.
• Improve equity by ensuring patients with transportation barriers receive comparable care.

Expected benefits include improved patient adherence to sleep studies, reduced delays in diagnosis, lower healthcare costs from untreated sleep apnea, and enhanced operational efficiency.

GAPS:

• System Gaps: No infrastructure currently exists for mailing home sleep studies.
• Technological Gaps: Limited integration of WatchPAT results with APeX (UCSF’s EHR system).
• Educational Gaps: Patients may require additional instructions for at-home testing.

INTERVENTION:
The proposed intervention will establish a process for UCSF Sleep Clinic to mail disposable WatchPAT devices to eligible patients. Itamar Medical will provide training and support for logistics, ensuring efficient distribution and return of devices. We will develop patient-friendly instructions and offer remote support to minimize user errors.

Target Population:

• UCSF Sleep Clinic patients residing outside the immediate area (5-10+ miles).
• Patients with advanced illness or mobility restrictions preventing travel.

Potential Barriers:

• Insurance coverage for mailed home sleep studies.
• Ensuring timely device return and compliance with testing protocols.

Mitigation Strategies:

• Partnering with UCSF billing and Itimar to navigate reimbursement.
• Developing clear patient communication materials to ensure proper device use.

PROPOSED EHR MODIFICATIONS:

• Current Workflow: Manual documentation and scheduling of in-lab studies.
• Desired Modifications: Integration of WatchPAT test orders/results within APeX.
• New Tools Needed: Automated workflows for tracking mailed devices and test completion.

RETURN ON INVESTMENT (ROI):

• Reduced costs associated with missed in-lab study appointments.
• Increased efficiency in diagnosing sleep apnea, leading to fewer complications and hospitalizations.
• Potential revenue from increased home sleep study volume.

SUSTAINABILITY:
If successful, UCSF can integrate this service into standard sleep study protocols. Key stakeholders (sleep clinic leadership, billing, and IT) will assess long-term funding sources, such as insurance reimbursements or UCSF operational budgets, to maintain and expand the program.

BUDGET (Up to $50,000):

• Devices & Supplies: Disposable WatchPAT units ($100 per unit).
• Staffing: Part-time coordinator to manage logistics.
• Software Integration: EHR modifications for workflow efficiency.
• Patient Education Materials: Printing and digital resources.