Health care delivery in a sleep center.

This report presents and describes measures developed for the tracking of care provided to patients referred for evaluation to a sleep clinic and center in a U.S. federal health facility. We provide qualitative and quantitative indicators, tracked for a two-year period of time, for system management, information flow, measures of consultation and subsequent identification of apneic activity (Respiratory Disturbance Index > 10) and treatment for sleep apnea, and the satisfaction with diagnostic testing and treatment. Measures of laboratory efficiency were generally stable, except for the time from the clinic visit to PSG and the time from PSG interpretation to the final written report. We have some evidence that patient satisfaction with CPAP/BiLevel care may vary with a change in a home health care provider. Also, there was a surprisingly high rate of replacement of masks during nasal CPAP therapy. Results indicate the feasibility of such an approach and identify certain areas for improvement in process and communication relevant to the management of sleep disordered breathing.