A year ago in Wisconsin, SSM Health and Stoughton Hospital’s primary payor began requiring most sleep studies be provided via home sleep testing. Jacalyn Nelson, MD, explains the resulting benefits and challenges for the hospital’s sleep services staff.
Excerpt from Sleep Review Magazine, published on
The Home Testing Curve
Speak to Nelson about her patients for only a few minutes and one thing becomes obvious: she is both highly conscientious and conservative when it comes to their care.
“She always has the patient’s interest in mind,” says Alexander. “The patient’s needs come first.”
Nelson makes a thorough evaluation of the patient’s health, including possible comorbidities, before she’ll approve an at-home sleep test. Only then will the patient be introduced to the concept of an HST.
“If home sleep testing is appropriate, I’ll have the nursing staff talk to the patient, show them how the home sleep device works, and provide written instructions and a video link,” she says. “The patients have multiple ways to understand how the device works.”
SSM Health currently uses CleveMed’s SleepView Direct for home sleep testing. The company sends the HST directly to the patient’s home, and, once the test is complete, CleveMed’s sleep staff does a first pass. If that data is deemed acceptable, it is passed along to the referring physician for interpretation.
Nelson admits that she’s probably still on the HST interpretation learning curve-getting used to having less data from which to make conclusions-and expects that as she becomes more experienced with the equipment and the equipment gets more sophisticated, interpreting will become more accurate and inconclusive results will taper off. For now, “I get a lot of studies I think are inconclusive,” Nelson says.
If an HST is deemed inconclusive, Nelson will order a follow-up in-lab study. This, again, reflects Nelson’s patient-centric approach to care. “I don’t want a patient to use a CPAP if they don’t need to,” she says.