Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea

Sarah Honaker, Tamara Dugan, Ameet Daftary, Stephanie Davis, Chandan Saha, Fitsum Baye, Emily Freeman, Stephen Downs

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA. Methods: A computer decision support system that automated screening for snoring was implemented in 5 urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children aged 1 to 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site. Results: PCPs suspected OSA in 20% of snoring children. Factors predicting PCP concern for OSA included clinic site (P < .01; odds ratio [OR] = 0.13), Spanish language (P < .01; OR = 0.53), provider training (P = .01; OR = 10.19), number of training years (P = .01; OR = 4.26) and child age (P < .01), with the youngest children least likely to elicit PCP concern for OSA (OR = 0.20). No patient health factors (eg, obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range, 6-28%) and between specific providers (range, 0-63%). Of children referred for polysomnography (n = 100), 61% completed the study. Of these, 67% had OSA. Conclusions: Results suggest unexplained small area practice variation in PCP concern for OSA among snoring children. It is likely that many children at risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.

Original languageEnglish (US)
JournalAcademic Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Obstructive Sleep Apnea
Primary Health Care
Pediatrics
Snoring
Odds Ratio
Polysomnography
Small-Area Analysis
Habits
Language
Obesity
Logistic Models
Demography

Keywords

  • Computer decision support
  • Obstructive sleep apnea
  • Pediatric
  • Primary care provider
  • Sleep disorders

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea. / Honaker, Sarah; Dugan, Tamara; Daftary, Ameet; Davis, Stephanie; Saha, Chandan; Baye, Fitsum; Freeman, Emily; Downs, Stephen.

In: Academic Pediatrics, 01.01.2018.

Research output: Contribution to journalArticle

@article{4923ec9b5ed140fabf09aaef10d5a3a6,
title = "Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea",
abstract = "Objective: To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA. Methods: A computer decision support system that automated screening for snoring was implemented in 5 urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children aged 1 to 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site. Results: PCPs suspected OSA in 20{\%} of snoring children. Factors predicting PCP concern for OSA included clinic site (P < .01; odds ratio [OR] = 0.13), Spanish language (P < .01; OR = 0.53), provider training (P = .01; OR = 10.19), number of training years (P = .01; OR = 4.26) and child age (P < .01), with the youngest children least likely to elicit PCP concern for OSA (OR = 0.20). No patient health factors (eg, obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range, 6-28{\%}) and between specific providers (range, 0-63{\%}). Of children referred for polysomnography (n = 100), 61{\%} completed the study. Of these, 67{\%} had OSA. Conclusions: Results suggest unexplained small area practice variation in PCP concern for OSA among snoring children. It is likely that many children at risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.",
keywords = "Computer decision support, Obstructive sleep apnea, Pediatric, Primary care provider, Sleep disorders",
author = "Sarah Honaker and Tamara Dugan and Ameet Daftary and Stephanie Davis and Chandan Saha and Fitsum Baye and Emily Freeman and Stephen Downs",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.acap.2018.01.011",
language = "English (US)",
journal = "Academic Pediatrics",
issn = "1876-2859",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Unexplained Practice Variation in Primary Care Providers' Concern for Pediatric Obstructive Sleep Apnea

AU - Honaker, Sarah

AU - Dugan, Tamara

AU - Daftary, Ameet

AU - Davis, Stephanie

AU - Saha, Chandan

AU - Baye, Fitsum

AU - Freeman, Emily

AU - Downs, Stephen

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA. Methods: A computer decision support system that automated screening for snoring was implemented in 5 urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children aged 1 to 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site. Results: PCPs suspected OSA in 20% of snoring children. Factors predicting PCP concern for OSA included clinic site (P < .01; odds ratio [OR] = 0.13), Spanish language (P < .01; OR = 0.53), provider training (P = .01; OR = 10.19), number of training years (P = .01; OR = 4.26) and child age (P < .01), with the youngest children least likely to elicit PCP concern for OSA (OR = 0.20). No patient health factors (eg, obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range, 6-28%) and between specific providers (range, 0-63%). Of children referred for polysomnography (n = 100), 61% completed the study. Of these, 67% had OSA. Conclusions: Results suggest unexplained small area practice variation in PCP concern for OSA among snoring children. It is likely that many children at risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.

AB - Objective: To examine primary care provider (PCP) screening practice for obstructive sleep apnea (OSA) and predictive factors for screening habits. A secondary objective was to describe the polysomnography completion proportion and outcome. We hypothesized that both provider and child health factors would predict PCP suspicion of OSA. Methods: A computer decision support system that automated screening for snoring was implemented in 5 urban primary care clinics in Indianapolis, Indiana. We studied 1086 snoring children aged 1 to 11 years seen by 26 PCPs. We used logistic regression to examine the association between PCP suspicion of OSA and child demographics, child health characteristics, provider characteristics, and clinic site. Results: PCPs suspected OSA in 20% of snoring children. Factors predicting PCP concern for OSA included clinic site (P < .01; odds ratio [OR] = 0.13), Spanish language (P < .01; OR = 0.53), provider training (P = .01; OR = 10.19), number of training years (P = .01; OR = 4.26) and child age (P < .01), with the youngest children least likely to elicit PCP concern for OSA (OR = 0.20). No patient health factors (eg, obesity) were significantly predictive. Proportions of OSA suspicion were variable between clinic sites (range, 6-28%) and between specific providers (range, 0-63%). Of children referred for polysomnography (n = 100), 61% completed the study. Of these, 67% had OSA. Conclusions: Results suggest unexplained small area practice variation in PCP concern for OSA among snoring children. It is likely that many children at risk for OSA remain unidentified. An important next step is to evaluate interventions to support PCPs in evidence-based OSA identification.

KW - Computer decision support

KW - Obstructive sleep apnea

KW - Pediatric

KW - Primary care provider

KW - Sleep disorders

UR - http://www.scopus.com/inward/record.url?scp=85043394723&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85043394723&partnerID=8YFLogxK

U2 - 10.1016/j.acap.2018.01.011

DO - 10.1016/j.acap.2018.01.011

M3 - Article

C2 - 29391284

AN - SCOPUS:85043394723

JO - Academic Pediatrics

JF - Academic Pediatrics

SN - 1876-2859

ER -