1215 Improving ISI Documentation Through Pre-Visit Electronic Questionnaire Completion in a VA Telemedicine Sleep Clinic

Abstract Introduction Insomnia is common among patients evaluated in sleep clinics, and standardized assessment is essential for guiding evidence-based management, including referral for cognitive behavioral therapy for insomnia (CBT-I). The Insomnia Severity Index (ISI) is a validated instrument for assessing symptom severity and treatment response. However, in telemedicine settings, in-visit ISI administration can be time-consuming and inconsistently completed. This quality-improvement initiative evaluated whether pre-visit electronic delivery of the ISI via the Veterans Affairs (VA) Mental Health Assistant (MHA) platform would improve questionnaire completion and availability at the point of care. Methods The intervention was implemented in fellow-led sleep telemedicine clinics at a VA Medical Center. From August 20, 2025 to November 7, 2025, patients scheduled for telemedicine visits received an electronic ISI via secure text and email through the MHA tool on the Monday before their appointment. ISI completion rates were prospectively recorded. Baseline ISI availability was assessed through retrospective chart review of encounters conducted between January 1 and June 30, 2025 in the same clinics. Primary outcomes included pre-visit ISI completion during the intervention period and documented ISI availability in the pre-intervention cohort. Results During the intervention period, 133 patients were scheduled and 104 attended. Seventy-one patients completed the ISI in advance, corresponding to a 53.4% completion rate among scheduled patients (95% CI: 44.9–61.9) and a 68.3% completion rate among those who attended (95% CI: 59.3–77.2). In the pre-intervention chart review of 234 encounters, ISI documentation was present in 32.9% (77/234; 95% CI: 26.9–38.9). This corresponds to a 35.4% increase in ISI availability at the visit compared with baseline. Clinicians informally noted that pre-visit completion reduced the need for in-visit questionnaire administration and improved perceived visit flow. Conclusion Pre-visit electronic administration of the ISI via the VA MHA platform significantly improved standardized insomnia assessment in a telemedicine sleep clinic. This scalable workflow enhancement increased data availability at the point of care and may facilitate more consistent, guideline-concordant insomnia management. Support (if any)