Do Respiratory Therapists Impact Positive Airway Pressure Adherence in the Home Care Setting?

Background: Staffing challenges within the respiratory care profession limit the availability of respiratory therapists (RTs). Within the homecare environment, availability of RTs is further limited. In the state of Michigan, home positive airway pressure (PAP) setups do not require an RT, however the importance of PAP adherence cannot be understated. Our home care company (large regional DME, all ages) transitioned the majority of PAP setups from RTs to trained unlicensed clinical assistants (CAs) to allow RTs to focus time on higher acuity needs. We aim to evaluate the relationship between trainer type during setup and patient adherence to PAP therapy. Methods: Change in practice from primarily RT PAP setups to CA at the headquarter location (Grand Rapids, MI) occurred in January of 2023. In an IRB exempt retrospective quality analysis, PAP adherence data from 2023 was reviewed to determine impact in patient adherence based on trainer type. De-identified patient data was collected from U-Sleep and Airview. Data metrics reviewed included quantity of PAP starts, setup trainer (RT versus CA), CMS adherence data met (4 h/night for 21/30 days), and the estimated cost of labor for PAP setup (average pay and average time). Data were exported to Excel and reviewed to determine impact based on practice change from RT to CA setups. Results: Overall adherence with PAP therapy, regardless of trainer type, was 65.5% (n = 3,239). There were 10 CAs and 9 RTs who completed PAP setups in the study period. Patients trained by RTs had a 65.6% adherence rate (n = 1,086) and trained by a CA had an adherence rate of 65.4% (n = 2,153). When reviewing only trainers with 100 or more setups in the year, adherence rate was 71.3% for RTs (680 PAP trainings done by 3 RTs) and 67.6% for CAs (2,083 PAP trainings done by 5 CAs). Based on an average training time of 45 min and an hourly rate of $30.92 per RT and $19.10 per CA, a PAP setup costs $23.19 by an RT and $14.33 by a CA. There were cost savings with this practice change, and it did not significantly affect overall patient adherence with PAP therapy. Conclusions: Clinicians are an important component of PAP setup for patients in the home environment. The use of a trained CA was not impactful for PAP therapy patient adherence when sampled, and significant cost savings were noted. Further studies must be done relative to trainer type, PAP adherence, and training/re-training time to determine impact more globally.Figure 1 details the difference in PAP compliance based on trainer type.