DNP - Open Access
Doctor of Nursing Practice (DNP)
Obstructive sleep apnea (OSA) is emerging as a significant health problem largely underrecognized by health care providers in the primary care setting (Pagel, 2008). The intent of this practice innovation project was to change and reduce the variation in practice for OSA screening that did not follow what is known about best practices. In this study, a preexperimental one-group pretest-posttest design was carried out to evaluate the outcomes associated with implementing an evidence-based screening pathway into practice for OSA based on the recommendations set forth in a clinical practice guideline recently published by the American Academy of Sleep Medicine (Epstein et al., 2009). The intervention consisted of providing education and training to primary care providers and staff for accurately identifying and screening eligible patients according to the pathway. Those individuals who were identified as having symptoms of OSA were referred on for a sleep study. Comparison data consisted of sleep study referral rates over a two month period prior to the intervention and were compared to sleep study referral rates over a two month period after the intervention was implemented into practice. The analysis indicates that there is not a statistically significant difference between the two groups (X2 = 1.091, p = 0.148). However, among the sub-group of patients identified as eligible for screening through chart review, significantly more patients were referred on for a sleep study during the post-intervention period compared to the pre-intervention period (X2 = 7.815, p = 0.003). Of the 227 patients identified as eligible for screening post-intervention, six were referred on for a sleep study. This result suggests with 95% certainty that the intervention (education and training for the implementation of a screening pathway) led to a statistically significant increase in the number of patients referred on for a sleep study. The majority of patients who were categorized as eligible for screening were White, male, age 50 years or younger, and indicated for screening due to their body mass index (>35 kg/m2). Results of this study demonstrate a small but clinically significant increase in the number of sleep study referrals after the pathway was implemented into practice. Despite the relatively few successful screenings that were performed in this study, there is still a need for ongoing screening in the primary care setting due to the increasing prevalence and debilitating conditions associated with OSA (Chai-Coetzer et al., 2013a). High patient volumes, time restraints, and neglecting to offer screening to every adult patient were identified as the major barriers to successfully implementing this project. Continued efforts are needed in educating providers about the importance of screening for OSA in the primary care setting. With the increasing prevalence of OSA, there is hope for earlier detection and prompter treatment with the advent of routine screening in the primary care setting.
Library of Congress Subject Headings
Sleep apnea syndromes
Sleep apnea syndromes -- Risk factors
Includes bibliographical references (pages 51-58)
Number of Pages
South Dakota State University
In Copyright - Educational Use Permitted
Fett, Emily, "Implementing a Screening Pathway for Identifying Patients at Risk for Obstructive Sleep Apnea in Primary Care" (2014). Doctor of Nursing Practice (DNP) Practice Innovation Projects. 33.