Implementation of CPAP telemonitoring and pay for performance scheme in France translated in personalized homecare provider actions

<bold>Objective:</bold> 1.8 million patients with obstructive sleep apnea (OSA) are currently treated with CPAP in France. Homecare provider (HP) fees are based on actual daily CPAP use and includes CPAP, consumables, telemonitoring, 24/7 call center and mandatory home visits. HPs can decide additional contacts, not reimbursed. The IMPACT-PAP study assessed i) the impact of these rules on HPs actions; ii) the relationship between adherence and intensity of HP support in the first year following CPAP initiation. <bold>Methods:</bold> Real-life descriptive study on data prospectively collected by HPs. CPAP adherence class was defined according to the reimbursement category: <2 (Low), 2-4 (Intermediate) and ≥4 hrs/day (High). Factors associated with 1 yr-adherence were analyzed using an ordinal logistic regression. <bold>Results:</bold> 11,166 patients initiated on CPAP were included (67% men; 60±13 years; BMI 32±7 Kg/m2). In the first month, the proportion of patients in the High, Intermediate, Low adherence classes were respectively 78.1%, 13.1% and 8.8%. The number of interactions patient-HPs during the first year was significantly different according to CPAP adherence class at 1 month (Fig 1). At 1 year, CPAP adherence improved by meanly 30 min; about 50% of Low and Intermediate shifted to the High adherence category. Factors associated with a higher adherence class were older age, male sex, High adherence at 1 month, and number of interactions with the HPs. <bold>Conclusion:</bold> CPAP telemonitoring and pay for performance scheme increased the number of high CPAP adherers, prioritizing allocation of HP resources to patients with low initial adherence.