Veterans Health Administration TeleSleep Enterprise-Wide Initiative 2017-2020: bringing sleep care to our nation's veterans

Victor S Chun; Mary A Whooley; Katherine Williams; Ning Zhang; Michelle R Zeidler; Charles W Atwood; Robert L Folmer; Annette M Totten; Connor J Smith; Eilis A Boudreau; Jill M Reichert; Kathleen F Sarmiento

doi:10.5664/jcsm.10488

Veterans Health Administration TeleSleep Enterprise-Wide Initiative 2017-2020: bringing sleep care to our nation's veterans

J Clin Sleep Med. 2023 May 1;19(5):913-923. doi: 10.5664/jcsm.10488.

Authors

Victor S Chun^{1

2}, Mary A Whooley^{3

4}, Katherine Williams^{3

4}, Ning Zhang^{3

4}, Michelle R Zeidler^{1

2}, Charles W Atwood^{5

6}, Robert L Folmer^{7

8}, Annette M Totten⁹, Connor J Smith⁹, Eilis A Boudreau^{9

10}, Jill M Reichert¹¹, Kathleen F Sarmiento^{4

12}

Affiliations

¹ Pulmonary, Critical Care, and Sleep Medicine, Veterans Administration (VA) Greater Los Angeles Health Care System, Los Angeles, California.
² Department of Medicine, University of California, Los Angeles, Los Angeles, California.
³ Measurement Science Quality Enhancement Research Initiative, San Francisco VA Health Care System, San Francisco, California.
⁴ Department of Medicine, University of California, San Francisco, San Francisco, California.
⁵ Sleep Medicine Program and Pulmonary Section, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania.
⁶ Division of Pulmonary, Allergy, Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania.
⁷ VA Portland Health Care System, Portland, Oregon.
⁸ Department of Otolaryngology, Oregon Health & Science University, Portland, Oregon.
⁹ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon.
¹⁰ Sleep Medicine and Epilepsy Program, VA Portland Health Care System, Portland Oregon.
¹¹ VA Specialty Care Program Office (11SPEC).
¹² Pulmonary, Critical Care, and Sleep Medicine, San Francisco VA Health Care System, San Francisco, California.

Abstract

Study objectives: The Veterans Health Administration cares for many veterans with sleep disorders who live in rural areas. The Veterans Health Administration's Office of Rural Health funded the TeleSleep Enterprise-Wide Initiative (EWI) to improve access to sleep care for rural veterans through creation of national telehealth networks.

Methods: The TeleSleep EWI consists of (1) virtual synchronous care, (2) home sleep apnea testing, and (3) REVAMP (Remote Veterans Apnea Management Platform), a patient- and provider-facing web application that enabled veterans to actively engage with their sleep care and sleep care team. The TeleSleep EWI was designed as a hub-and-spoke model, where larger sites with established sleep centers care for smaller, rural sites with a shortage of providers. Structured formative evaluation for the TeleSleep EWI is supported by the Veterans Health Administration's Quality Enhancement Research Initiative and was critical in assessing outcomes and effectiveness of the program.

Results: The TeleSleep EWI launched with 7 hubs and 34 spokes (2017) and rapidly expanded to 13 hubs and 63 spokes (2020). The TeleSleep EWI resulted in a significant increase in rural veterans accessing sleep care by utilizing home sleep apnea testing to establish a diagnosis of obstructive sleep apnea and virtual care for follow-up. Rates of virtual care utilization were greater in hubs and spokes participating in the TeleSleep EWI compared with non-EWI sleep programs. Additionally, veterans expressed satisfaction with their virtual care TeleSleep experiences.

Conclusions: The TeleSleep EWI successfully increased sleep care access for rural veterans, promoted adoption of virtual care services, and resulted in high patient satisfaction.

Citation: Chun VS, Whooley MA, Williams K, et al. Veterans Health Administration TeleSleep Enterprise-Wide Initiative 2017-2020: bringing sleep care to our nation's veterans. J Clin Sleep Med. 2023;19(5):913-923.

Keywords: Veterans Administration; rural; sleep; telehealth.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Humans
Sleep
Sleep Apnea Syndromes*
Telemedicine* / methods
United States
United States Department of Veterans Affairs
Veterans Health
Veterans*