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Tools Background

Tools Background

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Tools Background

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  1. Tools • Background • In August 2013, NMCP Boice Sleep Lab recognized detrimental sleep consult numbers effecting sailors and Marines and their beneficiaries. The tripled amount of monthly sleep consults (600+) showed less than 30% were positively diagnosed with Obstructive Sleep Apnea (OSA). Due to newly identified overuses, the Health Analysis department proposed more effective referral criteria to decrease the percentage of negative diagnostic sleep studies. Effective use of this tool will decrease the amount of Purchased Care and “retirement” sleep studies, allowing/accepting 100% of Active Duty consults and a potential cost avoidance of $400K per month. • Provider Sleep Study Referral Guidelines • The sleep study algorithm includes sleep apnea scenarios and symptoms that result in consult referrals from primary care physicians. The tool starts determining necessary action after: • First indication (hypersomnia/fatigue, snoring or witness to gasping at night) is selected. • Based on the initial selection, the second indication requests degree and timeframe of symptoms by using various documents, like nocturnal respiratory symptoms, a sleepiness scale, medications that cause sleepiness, etc., to help determine patients third indication of sleep apnea. • In most cases, a recommendation and/or referral follows the third indication field. • Recommendations include: • Review of proper sleep habits/methods, sleep strategies for shift work, obtaining and maintaining a sleep dairy. • Referral to sleep clinic for consult and/or study. • **Continue selecting applicable indications until recommendation is reached** • Web Based Medical Provider Informational Links: • Differential Diagnoses of Nocturnal Respiratory SymptomsEpworth Sleepiness Scale (ESS) Medications Known to Cause Sleepiness • STOP-BANG QuestionnaireSecondary Causes of HypersomniaInsomnia Referral Guidelines • Conservative Measures Informational Links: • Proper Sleep HabitsSleep Strategies for Shift WorkersSleep Diary • Sleep Foam Wedge PillowBeck’s Depression Inventory • For More Information, Please Visit: • health-analysis@nmcphc.med.navy.mil (actual website: http://www.med.navy.mil/sites/nmcphc/health-analysis/Pages/default.aspx) Website Draft (V2.0):

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