0442 Real-World Sustainability of Digital CBT-I: Healthcare System Implementation to Self-Sustaining Adoption

Abstract Introduction Despite Cognitive Behavioral Therapy for Insomnia (CBT-I) being the recommended first-line treatment, prescription sleep medications remain the most commonly utilized option in practice. Patients and physicians frequently express dissatisfaction with current care and may lack knowledge about digital CBT-I. Fully automated digital CBT-I offers a scalable solution with immediate, standardized, and convenient access to evidence-based treatment, potentially overcoming barriers related to provider availability and geographical limitations. Yet, despite its evidence base, digital CBT-I remains underutilized in US healthcare system settings. Demonstrating scalable, self-sustaining implementation is now needed. Methods This implementation study evaluates whether digital CBT-I (SleepioRx) could achieve sustained adoption after active implementation support ended. We offered digital CBT-I across Henry Ford Health System using Normalization Process Theory (NPT) as a guiding framework. Staff training sessions and systematic reminders were provided to facilitate provider engagement and patient uptake for the first 18 months (June 2023–December 2024). Patients presenting with insomnia were consecutively offered SleepioRx via the Epic electronic health records system. Implementation was assessed through electronic order rates and provider workflow acceptability during and after the active implementation period. Results By December, 2025, N=4,487 patients were ordered digital CBT-I across Henry Ford's clinical system (150 per month). During the 18-month active implementation period (June 2023–December 2024), N=2,576 patients received an order (143 per month). In the 12 months following cessation of active implementation efforts, N=1,911 additional patients were ordered treatment; representing a sustained monthly adoption rate of approximately 159 patients/month post implementation support. Adapting the electronic order process enabled clinicians to provide immediate digital access without disrupting workflows over time. This continued expansion despite cessation of active implementation support highlights the entrenchment and self-sustaining adoption of digital CBT-I as routine clinical treatment. Provider feedback indicated digital CBT-I enhanced stepped care-based insomnia treatment delivery without increasing workload. Conclusion This implementation study demonstrates that digital CBT-I can achieve self-sustaining clinical adoption. The 75% increase in patient orders after active implementation ceased provides robust evidence that NPT-guided embedding creates durable practice change. Support (if any) Big Health Inc. provided access to SleepioRx for Insomnia. The study was conducted as part of Henry Ford Health System's digital therapeutic implementation initiative.