Hospitals spend significant effort finding new patients. Some of the most important clinical need, however, is already inside the building: patients admitted for heart failure, COPD, diabetes or hypertension who also carry a cardio-pulmonary condition nobody has identified.
Obstructive sleep apnea is the clearest example. Company estimates indicate that 90% of people with obstructive sleep apnea are undiagnosed. Many of them are not strangers to the health system. They are already being treated, sometimes repeatedly, for conditions closely linked to the one they do not know they have.
Why the need goes unrecognized
Undiagnosed patients rarely arrive with a clear complaint. Their symptoms are easy to attribute to something else: fatigue to age, morning headaches to stress, poor control of blood pressure or blood sugar to medication adherence. In a busy unit, the immediate reason for admission takes priority, and the question of what happens at night is seldom asked.
Even when the question is asked, the traditional path to an answer can be slow and selective. If a patient has to meet a set of criteria before anyone looks, many patients with real need never get looked at.
The CKM connection
The overlap between cardio-pulmonary disease and CKM (cardiac, kidney and metabolic) conditions is what makes this a hospital issue, not just an outpatient one. CKM conditions include hypertension, coronary artery disease and Type II diabetes, and they make up a large share of every hospital’s census.
Respiratory disease follows the same pattern. Company estimates indicate that 11% to 16.5% of Medicare and Medicaid patients have COPD, and 70% of them also have a CKM condition. The patients a respiratory department sees and the patients cardiology and internal medicine see are, very often, the same people. We cover that overlap further in COPD Rarely Travels Alone: The CKM Connection.
When an underlying cardio-pulmonary condition goes unaddressed, it can complicate the management of everything else. Identifying it is one of the more direct ways to support the whole patient.
Identifying need with a Practice-Based Protocol
EBM Health Care Strategies approaches this through Hybrid Overnight Oximetry, a Practice-Based Protocol (PBP) for cardio-pulmonary disease that runs from screening through the management of therapeutics such as CPAP and oxygen therapy. The protocol gives the care team a structured, repeatable way to look for need rather than waiting for it to announce itself.
Because the approach requires no CPT codes, no payer qualification and places no limits on who can be included, the hospital is not forced to narrow the search to a qualifying subset. A protocol can be applied to the patients who fit it, regardless of age, diagnosis, symptoms or insurance type.
The resulting Hybrid Oximetry Report gives the prescriber evidence to decide what comes next. If therapy is started, the same protocol continues to measure whether it is being used and whether it is helping. Our overview of the protocol, Hybrid Overnight Oximetry explained, walks through each stage.
Finding the need is only half of it
Identification without follow-through does not help the patient. Company estimates indicate that of the patients who are diagnosed with obstructive sleep apnea, half fail the most common treatment within a year. That is why the protocol continues after diagnosis.
- Patients answer a short daily set of questions on their own phone, in about thirty seconds a day.
- Answers reach the care team’s dashboard in real time, and out-of-range readings raise an alert the same day.
- Fourteen-day trends show whether the therapy is being used and whether the patient is improving.
- Respiratory therapists and the rest of the care team can coordinate through one channel, with time captured automatically.
Physicians stay in control of every clinical decision. EBM handles the between-visit workload, escalates what needs attention and documents the work.
What it means for the hospital
For hospital leadership, the patients described here are already part of the hospital’s population and its costs. A protocol that identifies and supports them is designed to improve care for patients who would otherwise remain invisible, and to give the respiratory department a clinical role well beyond the bedside. It does so without hiring, equipment purchases or an IT build-out. Our Hospitals page explains how the model is deployed.
The starting point is simple: decide which patient group to begin with, and let the protocol show what has been missed.
See it with your own patient population
We will help you choose a patient group, apply the Hybrid Overnight Oximetry protocol to it, and show you what the reports reveal. Request a demonstration or call (833) 837-8881.