Utilizing Compliance Software For Quality Improvement: The Howard University Hospital Experience

Previous studies have assessed the influence of demographic and clinical variables regarding PAP adherence, including race, but less is known whether these variables predict outcomes within a minority population. Here we demonstrate the process to utilize readily available PAP manufacturer software to compare community outcomes with national data, and review the influence of demographic and clinical variables within a specific population. Data is also utilized to evaluate temporal patterns in outcomes and demographics. We present data describing a program serving a historically low income, minority predominant population that has seen radical change in population demographics. We analyzed patients undergoing PAP treatment at the Howard University Sleep Disorders Center in Washington, D.C.. De-identified information was collected from all patients enrolled in an online patient data management program (Encoreanywhere, Philips Respironics) from 11/2008 to 12/2018. 802 patients.were assessed regarding setup date, birth date/age, gender, CPAP machine pressure (minimum and maximum pressure), address/zip code, and CMS compliance. PAP adherence by CMS criteria (>70% of nights within a 30 day period with usage >4h/night) during the first 90 days was 36% from 2008 to 2018. A weak trend toward increasing compliance over time was present, although yearly outcomes varied significantly. Younger age and female gender negatively correlated with compliance. Machine pressures did not show a correlation with compliance. Zip codes were used to track geographic differences in outcomes. Temporal variation in our population demographics showed a trend toward younger and more male patients. When compared to a study of national data utilizing a similar approach, our data from a predominantly under-served, minority population demonstrated relatively reduced rates of PAP adherence. Lower PAP adherence associated with lower age and female sex, as has been seen in some but not all studies. Identifying challenges with compliance, we hope that our data will serve as a benchmark for a quality improvement initiative to improve outcomes and that this study will be useful to delineate the process for other clinicians to utilize such programs. None