Quality Assurance Fact Sheet

Applicable Accreditation Standards

Facilities must have a QA program that addresses the following indicators:

  1. A process measure for OSA;
  2. An outcome measure for OSA;
  3. An outcome measure for another sleep disorder (e.g. RLS, Insomnia or Narcolepsy); and
  4. Inter-scorer reliability as outlined in Standard F-7.

These measures may be chosen from the AASM Quality Measures (available at https://aasm.org/clinicalresources/practice-standards/quality-measures/).

The facility must establish minimal thresholds for the quality assurance metrics. Quarterly, the facility director must attest to the effectiveness of quality improvement efforts and address plans for remediation of metrics that do not meet the minimal threshold. Quarterly reports must be signed and dated by the facility director and maintained for at least five years.

A complete QA program includes maintaining a comprehensive written policy that describes specific clinical indicators to be monitored by the facility, as well as a written quarterly report that summarizes the analysis results. The facilities QA program should monitor the following:

  1. A process measure for OSA
  2. An outcome measure for OSA
  3. An outcome measure for another sleep disorder
  4. Inter-scorer reliability

Indicator Development

When selecting indicators, a facility may develop their own through facility collaboration or select from the AASM published Quality Measures. When developing indicators consider the following:

  • Process measures indicate what ACTION the facility does to improve the health of those diagnosed with a specific sleep disorder.
  • Outcome measures indicate the IMPACT that these actions have had on the health status of these patients.
  • Measurement/Methodology is the tool used to support the evidence gathered.
    • Example: Process measures may use the medical record or patient encounter documentation note (questionnaires etc.). Outcome measures may use sleep measurement tools such as SAQLI (Sleep Apnea Quality of Life Inventory) or FOSQ (Functional Outcome of Sleep Questionnaire).
  • Threshold(s) are used to determine the goal the facility hopes to achieve, usually expressed as a percent (e.g.85%)

Examples of AASM Quality Measures:

Clinical Outcome Measure for OSA Improve Quality of Life
Clinical Outcome Measure for Insomnia Improve Daytime Functioning
Clinical Outcome Measure for Narcolepsy Reduce Excessive Daytime Sleepiness
Clinical Outcome Measure for RLS Decrease RLS Symptoms Severity
Process Measure for OSA Baseline Assessment of OSA Symptoms
Process Measure for OSA Assessment of Sleepiness

DATA Analysis

Quarterly the facility must gather collected data. Review and analyze the results to determine if the minimal threshold have been met.

  • Formula for calculating measure: # meeting measure ÷ sample size = % who met the measure
    • Example: 10 meet a measure ÷ 20 randomly selected medical records = 50%

Through this evaluation, there is opportunity to improve clinical outcomes and processes by identifying problem areas resulting in a negative outcome.

Remediation of Metrics

Through evaluation of data and the established threshold (goal), conclusions can be drawn. Quarterly the Facility Director must address plans for remediation for indicators that did not meet the minimum threshold.   Quarterly new indicators may be chosen if the facility director decides the goal has been met.

Record Keeping Requirements

Written quarterly reports must be signed and dated by the Facility Director and maintained for at least five years. By signing the report, the Facility Director is attesting to the effectiveness of the quality improvement efforts. The report must address the indicators, minimal thresholds and remediation if warranted.

QA Practical Recommendations

  • When selecting a clinical outcome, remember to choose a sleep disorder that is specific to the facility.
  • Sample size is set by the facility. It is not necessary to do all patients.
  • Determine what processes you may already have in place to evaluate if the outcome has been achieved.
  • Implement realistic tools that will enable patients to give you data quickly.
    • Example: Use short questionnaires or surveys that can be completed by either patient’s in the office, or ancillary staff without increasing the work load.
  • When determining the minimal threshold expectation; be realistic in defining your goal. Look at where you are now and identify where you would like to be. Thresholds can be modified/increased after each quarter.

Key Things to Keep In Mind

  • Quarterly, data is collected, compiled and an analysis is performed that results in a summary report.
  • The Facility Director reviews the quarterly report and addresses plans for remediation if thresholds have not been met.
  • A complete QA report is to include results for ISR and is signed and dated by the Facility Director.
  • Annually the facility director should evaluate the effectiveness of the quality improvement program and determine if other indicators may be needed, which may require future monitoring