Inpatient sleep disturbance has been linked to clinically relevant and detrimental outcomes such as delirium and falls; both are known risk factors for morbidity, mortality, prolonged hospital stays, and increased healthcare costs. Based on our preliminary work of inpatient sleep and incorporating the design of other successful health information technology (IT) interventions developed by our team members, we have developed a prototype of a sleep promotion tool kit (SLEEPkit). Using the SLEEPkit, patients start the assessment of sleep and sleep disturbing factors during the previous night. The SLEEPkit software identifies a core set of evidence-based interventions directly linked to the patient-specific sleep disturbing factors. The assessment data and the associated tailored interventions are then processed by the SLEEPkit software to generate a single care plan for sleep and personalized educational content for all care providers, patients, and family members. The SLEEPkit will be integrated into an existing web-based patient portal and easily accessed from mobile devices (e.g., iPad) at the bedside by patients and their care partners. Responding to the AHRQ PA-14-001, the goal of this R21 project is to inform the development of the SLEEPkit by conducting iterative refinement, implementation, and pilot evaluation guided by the RE-AIM framework. The RE- AIM framework emphasizes the Reach, Effectiveness, Adoption, Implementation, and Maintenance of a health IT intervention in the actual clinical setting. Specifically, we will 1) iteratively refine a patient-centered SLEEPkit and integrate it as an enhancement into an existing web-based patient portal; 2) To implement the SLEEPkit on an oncology patient-care unit where the web-based patient portal is currently in place; and 3) To pilot test the effectiveness of the SLEEPkit on patient's self-perceived overall sleep quality during hospitalization. Based on the primary outcome of interest, self-perceived sleep quality measured by the PROMIS Sleep Disturbance, we plan to enroll a total of 120 patients for this pilot study. Findings of this project will inform further development and refinement of the SLEEPkit, which aims not only to improve inpatient sleep but also to be well integrated to clinical and patient workflow. The pilot evaluation will also inform the effect size of study outcomes for a future randomized controlled trial to evaluate the SLEEPkit application. Consistent with the AHRQ mission, this will lay the groundwork for making inpatient sleep promotion effective and feasible, which will ultimately change current clinical practice related to patient sleep, hence leading to meaningful improvement in patient health, outcomes, quality of care, and cost.
Improving sleep for hospitalized patients is an essential clinical need. Inpatient sleep disturbance has been linked to clinically relevant and detrimental outcomes such as delirium and falls; both of which are known risk factors for morbidity, mortality, prolonged hospital stays, and increased healthcare costs. Patient-centered care is critically needed to improve inpatient sleep. Critical to optimizing recovery from illness, sleep should be regularly assessed and routinely addressed as part of the clinical care for every hospitalized patient. As a health information technology intervention, sleep promotion tool kit (SLEEPkit), shows unique advantages to support patient-centered care to improve inpatient sleep. Findings of this project will inform further development and refinement of the SLEEPkit, which aims not only to improve inpatient sleep but also to be well integrated to clinical and patient workflow. Consistent with the AHRQ mission, this will lay the groundwork for making inpatient sleep promotion effective and feasible, which will ultimately change current clinical practice related to patient sleep, hence leading to meaningful improvement in patient health, outcomes, quality of care, and cost.
| Ye, Lichuan; Richards, Kathy C (2018) Sleep and Long-Term Care. Sleep Med Clin 13:117-125 |
