Download Homogeneous vs. Heterogeneous Environments and Impact on

Homogeneous vs. Heterogeneous Environments and
Impact on Sleep Therapy Compliance
Contributors
Jacob McCabe, RN, Clinical Educator, National Sleep Therapy
Eric Cohen, Co-Founder, researcher, National Sleep Therapy
Executive Summary
Currently, most sleep therapy equipment is delivered to a patient diagnosed with sleep apnea in the home (heterogeneous
environment). This delivery model is susceptible to quality and consistency variations that can have a significant negative
impact on clinical outcomes. Using this model typically results in CPAP adherence of less than 50%. In contrast, using the
National Sleep Therapy model, CPAP dispensing and education is provided in the clinical setting (homogenous
environment). This is shown to substantially raise CPAP compliance and patient engagement. National Sleep Therapy
works with physicians and sleep centers to raise compliance using advanced clinical protocols showing compliance rates
as high as 84% and patient satisfaction of 99.44%.
Environment variations
Homes are considered heterogeneous environments due to their variability and unpredictability from patient to patient. No
two homes are identical and therefore heterogeneous. Children, pets, lack of space, television, and other distractions are a
routine part of every traveling homecare worker’s day-to-day experience. The heterogeneous environment typically has
uncontrolled lighting, sound and space. General environmental conditions are not conducive to the focus and attention
required for learning, long-term patient engagement and positive outcomes.
By contrast, the clinical environment in a sleep center or physician practice is better suited for proper education and
engagement of the sleep therapy patient. This homogeneous environment (controlled and standardized for all patients)
affords the ability to provide every sleep therapy patient with a consistent and “designed” experience that leverages best
practices and established clinical protocol. Patient outcomes can be measured and environments can be adjusted to further
improve outcomes in a controlled and measureable system. Patients show greater respect for the sleep therapy process
when introduced in a clinical setting.
Role of Environment on Therapy
Sleep Therapy is a process rather than a single diagnostic and therapeutic event that can often require ongoing patient
interaction, support, counsel, and equipment modification. It is demonstrated that patient engagement is critical to longterm therapeutic benefit. When patients are engaged in the therapeutic process, compliance is higher. Therefore, the initial
patient education and engagement is critical to long-term success.
Heterogeneous setting and the negative impact on compliance
In the heterogeneous setting, there are a number of factors that decrease quality of the experience and long-term patient
outcome:
Scheduling problems
Patients are more likely to delay appointments making subsequent appointments
late, which results in a severely compromised patient experience.
Clinician variability
Aside from the fact that many “DME” companies deliver CPAP to patients using
untrained employees, even when clinicians carry out this function, variability
from clinician to clinician is considerable. For this reason, the ability to train and
deliver a compassionate, engaging educational experience to the patient is
compromised and cannot be guaranteed to meet any minimum standards for best
practice.
Framework and learning
The home environment lacks a framework conducive for learning. Optimal
education relies on the ability of the learner (i.e. the patient) to understand and
internalize information in such a way that it is perceived relevant and
meaningful. Helping patients achieve the necessary “openness” for learning is
difficult due to the variability of the skill set of the person delivering equipment
(driver? clinician? mailman?) and the environment at the time. Patients often
report, “They dropped off my equipment and told me how to use it. I don’t
remember anything about it. I need help.”
Lack of focus
In the home setting, variability in this environment ranges from friendly and
inviting, to dangerous and nonconductive to any clinical education. Many
clinicians report conditions so uncomfortable that they were only able to drop off
equipment and would not enter the home. While these environments are not ideal
for proper clinical education, they may also put healthcare workers at risk.
Because heterogeneous environments are unpredictable and do not facilitate a consistent patient education experience, the
industry, in using this model, demonstrates compliance rates of less than 50% unless substantial provider involvement
occurs in the clinical setting. The authors acknowledge that there are some home settings and clinicians that in
combination can lead to good patient outcomes. This scenario is the exception rather than the norm and should not be
relied upon for high quality patient care. The goal of a consistent point of care education and set up process is to control
those factors that can be controlled and thereby maximize the possibility of better compliance and resulting outcomes.
Homogeneous environments (clinical setting) and high compliance
In the homogeneous setting, there are a number of factors that increase the quality of the experience and long-term patient
outcome:
Patient Expectations
Patients are more likely to keep appointments with the expectation that they will
meet an expert in the sleep field that will support their clinical needs. They tend
to have more respect for a clinician’s time in the clinical environment than in
their home environment.
Clinical Access
Participating in a defined process in the clinical setting provides the opportunity
for a patient to have immediate access to additional resources as necessary. For
example, a physician can be involved with the patient as a set up is being
conducted to confirm the diagnosis and support the entire process.
Consistent Education
Every patient receives a consistent, high quality education using a carefully
designed clinical protocol in a controlled setting. This consistency enables
providers to deliver high quality care more efficiently due to the educational
foundation provided at the initiation of CPAP therapy. iPads and other techniques
are employed to inform, empower, and engage patients.
Trust and Collaboration
With proper messaging during CPAP education, and due to the physical
proximity of CPAP in the clinical setting, patients associate therapy with a
clinical need. This association provides patients with a greater awareness as to
the importance of CPAP therapy and overall health thus improving compliance.
Patients enter a system of “closed-loop” collaboration between provider and
National Sleep Therapy whereby information is shared consistently and quality
of care is increased.
Long-term engagement
When the CPAP initiation process is controlled, patient engagement increases.
Increased engagement results in an increase in “permission to support” and
ultimately favors long-term adherence to CPAP therapy.
Summary
Traditional methods for delivering sleep therapy equipment in the home setting are sub-optimal and result in low industry
compliance averages. The home (heterogeneous) environment lacks the structure and control required to follow a best
practice protocol to raise patient engagement and compliance. By contrast, following National Sleep Therapy’s education
protocol, administered in a controlled clinical setting (homogeneous), results in substantially higher CPAP compliance
rates as high as 84% and patient satisfaction of 99.44%. In addition, self-reported patient data suggests a greater
percentage of patients experiencing the overall health benefits of CPAP therapy including weight-loss, reduced
dependency on medications, improved daily function, and an overall better outlook on life.