Sleep Disorders and Sleep Deprivation: An Unmet Public

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Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem http://www.nap.edu/catalog/11617.html BUILDING SLEEP PROGRAMS IN ACADEMIC HEALTH CENTERS 321 Chronic Care Accreditation Standards As described earlier in this chapter, sleep disorders are chronic conditions with complex treatments. However, despite the importance of early recognition and treatment, the primary focus of most existing sleep centers is on diagnosis rather than on comprehensive management of sleep loss and sleep disorders as chronic conditions. This narrow focus may largely be the unintended result of compliance with criteria for accreditation of sleep laboratories, which emphasize diagnostic standards and reimbursement, for diagnostic testing. Clinical accreditation standards should be updated to address patient care needs. Chronic disease management models, such as those used to provide optimal care for individuals with diabetes, asthma, congestive heart failure, and depression, have been proven to be effective at providing betterintegrated care (Tsai et al., 2005). Therefore, the committee recommends that accreditation criteria for all sleep centers, embedded in either academic health centers or private sleep laboratories, be expanded to emphasize treatment, long-term patient care, and management strategies. Although sleep laboratories may face a financial burden implementing the changes, the committee believes this is the most effective way to ensure optimal patient care. Such criteria should be subject to further analysis and a demonstration that chronic care is a worthwhile investment. If such studies demonstrate a benefit, this may then change reimbursement patterns. Recommendation 9.2: Sleep laboratories should be part of accredited sleep centers, the latter to include long-term strategies for patient care and chronic disease management. All private and academic sleep laboratories should be under the auspices of accredited sleep centers and include adequate mechanisms to ensure long-term patient care and chronic disease management. Accreditation criteria should expand beyond a primary focus on diagnostic testing to emphasize treatment, long-term patient care, and chronic disease management strategies. REFERENCES AASM (American Academy of Sleep Medicine). 2006a. Standards for Accreditation of Sleep Disorders Centers. [Online]. Available: http://www.aasmnet.org/PDF/CenterStandards. pdf [accessed January 3, 2006]. AASM. 2006b. Accreditation Standards. [Online]. Available: http://www.aasmnet.org/center Lab.aspx [accessed January 18, 2006]. Allison PJ, Nicolau B, Edgar L, Archer J, Black M, Hier M. 2004. Teaching head and neck cancer patients coping strategies: Results of a feasibility study. Oral Oncology 40(5):538–544. Copyright © National Academy of Sciences. All rights reserved.
Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem http://www.nap.edu/catalog/11617.html 322 SLEEP DISORDERS AND SLEEP DEPRIVATION Baker TL, Guilleminault C, Nino-Murcia G, Dement WC. 1986. Comparative polysomnographic study of narcolepsy and idiopathic central nervous system hypersomnia. Sleep 9(1 pt 2):232–242. Benca RM. 2005. Diagnosis and treatment of chronic insomnia: A review. Psychiatry Services 56(3):332–343. Bodenheimer T, Wagner EH, Grumbach K. 2002. Improving primary care for patients with chronic illness. Journal of the American Medical Association 288(14):1775–1779. Bunton SA. 2006. Recent trends in basic science department reorganizations. American Association of Medical Colleges Analysis in Brief 6(1)1–21. Cherniack NS. 2005. Sleep apnea and insomnia: Sleep apnea plus or sleep apnea minus. Respiration 72(5):458–459. Chung KF. 2005. Insomnia subtypes and their relationships to daytime sleepiness in patients with obstructive sleep apnea. Respiration 72(5):460–465. Chung SA, Jairam S, Hussain MR, Shapiro CM. 2001. Knowledge of sleep apnea in a sample grouping of primary care physicians. Sleep and Breathing 5(3):115–121. Davidson JR, Waisberg JL, Brundage MD, MacLean AW. 2001. Nonpharmacologic group treatment of insomnia: A preliminary study with cancer survivors. Psycho-Oncology 10(5):389-397. Ehrenberg RG, Epifantseva J. 2001. Has the growth of science crowded out other things at universities? Heldref Publications/Gale Group 26:46–52. Ehrenberg RG, Rizzo MJ, Jakubson GH. 2003. Who Bears the Growing Cost of Science at Universities? [Online] Available: http://www.nber.org/papers/w9627 [accessed December 15, 2005] (unpublished work). Epstein DR, Bootzin RR. 2002. Insomnia. The Nursing Clinics of North America 37(4):611–631. Hendricks JC, Finn SM, Panckeri KA, Chavkin J, Williams JA, Sehgal A, Pack AI. 2000. Rest in Drosophila is a sleep-like state. Neuron 25(1):129–138. Hillman AL. 1991. Managing the physician: Rules versus incentives. Health Affairs (Millwood) 10(4):138–146. IOM (Institute of Medicine). 2000. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press. IOM. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press. Kapur V, Strohl KP, Redline S, Iber C, O’Connor G, Nieto J. 2002. Underdiagnosis of sleep apnea syndrome in U.S. communities. Sleep and Breathing 6(2):49–54. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF. 1993. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. American Review of Respiratory Diseases 147(4): 887–895. Lach S, Schankerman M. 2001. Organizational structure as a determinant of academic patent and licensing behavior: An exploratory study of Duke, Johns Hopkins, and Pennsylvania State Universities. Journal of Technology Transfer 26(1):21–35. Lach S, Schankerman M. 2003. Incentives and Invention in Universities. [Online] Available: http://www.nber.org/papers/w9727 [accessed December 15, 2005] (unpublished work). Lee K, Cho M, Miaskowski C, Dodd M. 2004a. Impaired sleep and rhythms in persons with cancer. Sleep Medicine Reviews 8(3):199–212. Lee KA, Landis C, Chasens ER, Dowling G, Merritt S, Parker KP, Redeker N, Richards KC, Rogers AE, Shaver JF, Umlauf MG, Weaver TE. 2004b. Sleep and chronobiology: Recommendations for nursing education. Nursing Outlook 52(3):126–133. Likar LL, Panciera TM, Erickson AD, Rounds S. 1997. Group education sessions and compliance with nasal CPAP therapy. Chest 111(5):1273–1277. Copyright © National Academy of Sciences. All rights reserved.
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