DISCORDANT OUTPATIENT AND INPATIENT OSA DIAGNOSES ON A GENERAL INTERNAL MEDICINE SERVICE

      SESSION TITLE: Late-breaking Abstracts
      SESSION TYPE: Original Investigations
      PRESENTED ON: October 18-21, 2020
      PURPOSE: Obstructive sleep apnea (OSA) affects 10-30% of adults, causing serious consequences if undiagnosed and untreated. The Joint Commission’s Division of Healthcare Improvement cited healthcare systems for failing to assess patients for OSA and lack of communication among health care providers regarding OSA patients. A recent study associated increased inpatient rapid response system events with OSA and reduced events with positive airway pressure (PAP) therapy (Sharma 2016), suggesting that pre-hospitalization outpatient OSA diagnoses should consistently be carried over into the inpatient setting to allow continuation of appropriate OSA treatment. We examine concordance of outpatient and inpatient OSA diagnoses as an indicator of optimal cross-continuum communication. Our goal was to determine the concordance of an OSA diagnosis during hospitalization on a general internal medicine (GIM) service, with a prior OSA outpatient diagnosis present in the electronic health record (EHR).
      METHODS: Penn State PaTH to Health is a research data repository from electronic health records of all Penn State Hershey Medical Center patients, conforming to the national standards of the PCORnet® Common Data Model. We identified all patients ≥18 years old hospitalized on the GIM service between January 1, 2017-December 31, 2018, then restricted our analysis to only their first admission. We determined whether patients had an inpatient OSA diagnosis during their inpatient admission using “Obstructive Sleep Apnea” (ICD-9 327.23, ICD-10 G47.33) or “Sleep Apnea, unspecified” (ICD-9 780.57, ICD-10 G47.3). We also determined whether these patients had a prior outpatient OSA diagnosis using the same codes during the five-year period January 1, 2012-December 31, 2016.
      RESULTS: The GIM inpatient cohort (first admission) included 13,067 patients (53% men, 87% white, 77% > 50yrs old). Comorbidities included 42% hypertension, 14% Type 2 diabetes mellitus, 15% congestive heart failure, 21% atrial fibrillation, and 0.5% stroke. Of the 13,067 patients, 991 (7.6%) had a prior outpatient OSA diagnosis during the five-year period January 1, 2012-December 31, 2016. Of these 991 patients, 615 (62.1%) had an inpatient OSA diagnosis while 376 (38%) did not. An additional 804 patients who did not have a preceding outpatient OSA diagnosis in our EHR had an inpatient diagnosis of OSA during their index admission.
      CONCLUSIONS: Discordant outpatient and inpatient OSA diagnoses are common among patients on a general internal medicine service. Prior outpatient OSA diagnoses were not carried forward into the inpatient setting 38% of the time. Persons who had an inpatient OSA diagnosis that was not previously identified in outpatient records comprised 6.2% of all GIM admissions.
      CLINICAL IMPLICATIONS: These data indicate the magnitude of opportunity for healthcare improvement focused on enhancing communication and optimizing cross-continuum care.
      DISCLOSURES: Site PI for pharmaceutical trials relationship with Boehringer-Ingelheim Please note: $1001 - $5000 Added 06/01/2020 by Rebecca Bascom, source=Web Response, value=Travel
      Site PI for pharmaceutical study relationship with Nitto Denko Please note: $1001 - $5000 Added 06/01/2020 by Rebecca Bascom, source=Web Response, value=Travel
      Site PI for pharmaceutical study relationship with Galapagos Please note: $1001 - $5000 Added 06/01/2020 by Rebecca Bascom, source=Web Response, value=Travel
      Other relationship with Nitto Denko Please note: $1001 - $5000 by Rebecca Bascom, source=Web Response, value=Travel
      Other relationship with Galapagos Please note: $1001 - $5000 by Rebecca Bascom, source=Web Response, value=Travel
      attended investigator meeting relationship with Nitto Denko Please note: $1001 - $5000 by Rebecca Bascom, source=Web Response, value=Travel
      attended investigator meeting relationship with Galapagos Please note: $1001 - $5000 by Rebecca Bascom, source=Web Response, value=Travel
      No relevant relationships by Cynthia Chuang, source=Web Response
      No relevant relationships by Wenke Hwang, source=Web Response
      No relevant relationships by Erik Lehman, source=Web Response
      No relevant relationships by Nitasa Sahu, source=Web Response