0483 Stakeholder Engagement Studios to Explore the Journey to Diagnosis of OSA Informed by Primary Care Providers and Patients

Abstract Introduction Barriers to obstructive sleep apnea (OSA) diagnosis include operational misalignments and miscommunications among patients, providers, industry, insurers, and the healthcare system. To explore this, we engaged stakeholders to examine determinants of OSA diagnosis in primary care to optimize trial planning. Methods We conducted two, separate, virtual, 1-hour stakeholder engagement studio sessions with Penn Medicine Primary Care Providers (n=6) and patients referred for OSA diagnostics within prior year (n=3). Facilitation guides were used to elicit barriers/facilitators to reaching diagnosis. Sessions were facilitated by a sleep physician and advanced practice sleep nurse with two note-takers in attendance. Rapid matrix analysis approach identified consistent themes within diagnosis barrier and facilitator categories. Themes were categorized by Safety Engineering Initiative for Patient Safety (SEIPS) work system domains: people (P), environment (E), tools (T), and tasks (T), PETT. Results Fourteen facilitators (2P, 3E, 3T, 6T) and 15 barriers (2P, 4E, 3T, 6T) were identified for “getting to OSA diagnosis.” Provider-level barriers include: hesitancy to provide anticipatory guidance to patients due to ambiguous workflows after referral, excessive referral order options, no access to templated patient instructions or quality education resources, confusing order panels and use of electronic health record (EHR) workarounds, and fragmented communication. Patient-level barriers include: timeliness of communication and care, sleep health unawareness, low technology literacy for EHR messaging, financial considerations, and insufficient follow-up from healthcare team. Provider facilitators include: classic OSA presentation, diagnosis decision aids, patient education resources, easy to find results in EHR, and low threshold to order referral due to knowledge about sleep. Patient facilitators include: trusted primary care relationship, choice of visit type (telehealth vs. in-person) and communication mode (phone call vs. text vs. EHR portal), active outreach/engagement by healthcare team, and access to educational materials. Conclusion Repeated studios, including stakeholders from varied sites, will further refine determinants with more saturation and validity. Engaging with stakeholders is supporting the design of a contextually relevant, end-user valued study to address undiagnosed OSA. Given the estimated high prevalence of undiagnosed OSA and the multiple stakeholders that contribute to the diagnostic process and experience, research-driven solutions will be impactful and better optimized with multi-level partnered research. Support (if any) K12HS026372