TY - JOUR
AU - J. Kaitz
AU - V. G. Vimalananda
AU - M. P. Charns
AU - G. M. Fix
A1 - 
AB - OBJECTIVES: Sleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders. METHODS: A qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care. RESULTS: We interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers. CONCLUSIONS: A range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.
AD - Sleep Medicine, VA Puget Sound Healthcare System, Seattle, Washington, USA. Electronic address: jenesse.kaitz@va.gov.; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.; Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, USA.; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA; Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA; Boston University School of Public Health, Department of Health Law, Policy and Management, Boston, Massachusetts, USA.
AN - 38519364
BT - Sleep Health
C5 - Healthcare Disparities
CP - 3
DA - Jun
DO - 10.1016/j.sleh.2024.01.007
DP - NLM
ET - 20240322
IS - 3
JF - Sleep Health
LA - eng
N2 - OBJECTIVES: Sleep disorders are wide-ranging in their causes and impacts on other physical and mental health conditions. Thus, sleep disorders could benefit from a multidisciplinary approach to assessment and treatment. An integrated care model is often recommended but is costly to implement. We sought to understand how, in the absence of an established organizational structure for integrated sleep care, providers from different clinics work together to provide care for sleep disorders. METHODS: A qualitative case study at one U.S. Department of Veterans Affairs (VA) medical center. We used a purposeful nested sampling strategy, combining maximum variation sampling and snowball sampling to recruit key staff involved in sleep care. RESULTS: We interviewed providers (N = 10) from sleep medicine, primary care, and mental health services. Providers identified the ubiquity of sleep disorders and a concomitant need for multidisciplinary care. However, they described limited opportunities for multidisciplinary interactions and consequently a negative impact on clinical care. Providers described fragmentation in two areas: among sleep specialists and between sleep specialists and other referring and managing providers. CONCLUSIONS: A range of interventions, based on setting and resources, could improve care coordination both among sleep specialists and between sleep and nonsleep providers. While integrated sleep specialist clinics could reduce care fragmentation, they may not directly impact coordination with referring providers, like primary care and general mental health, who are essential in managing chronic conditions. Future work should continue to explore improving care coordination for sleep problems to ensure patients receive high-quality, timely, patient-centered care.
PY - 2024
SN - 2352-7218
SP - 342
EP - 347+
ST - Multidisciplinary providers' perceptions of care delivery for sleep disorders: A qualitative case study
T1 - Multidisciplinary providers' perceptions of care delivery for sleep disorders: A qualitative case study
T2 - Sleep Health
TI - Multidisciplinary providers' perceptions of care delivery for sleep disorders: A qualitative case study
U1 - Healthcare Disparities
U3 - 10.1016/j.sleh.2024.01.007
VL - 10
VO - 2352-7218
Y1 - 2024
ER -