0395 Effectiveness of a Digital Clinical Decision Support Platform to Augment CBTI Capability Gaps in the DHA/DoD
Anne Germain, Megan Wolfson, John Blue Star, Emmanuel Espejo, Vincent MysliwiecAbstract
Introduction
Insomnia is the most prevalent sleep disorder among active duty service members (ADSMs) and compromises readiness. Cognitive-behavioral therapy for insomnia (CBTI) is the DoD/VA recommended treatment, but access and delivery of CBTI is impeded by gaps between high patient demand for care and clinical capabilities. We evaluated the effectiveness of a digital clinical decision support (CDS) platform to overcome current CBTI capability gaps.
Methods
Mental healthcare providers (MHCPs) at military clinics were offered access to a novel CDS platform (COAST, NOCTEM® Health, Inc) to treat patients they deemed appropriate for this CBTI delivery mode. The platform consists of (1) clinician portal to remotely monitor and manage patients’ symptoms, progress, and adherence to algorithm-based, MHCP-approved treatment recommendations; (2) patient app that prospectively collects sleep diaries and displays MHCP-approved treatment recommendations (e.g., stimulus control, sleep restriction). The primary outcomes were treatment response (50% reduction in sleep latency (SL) or wake after sleep onset (WASO); increase of > 10% in sleep efficiency (SE)) and insomnia remission (response & SL & WASO < 30 minutes with SE > 85%) at the end of treatment. The magnitude of changes in diary-based SL, WASO, and %SE were compared from baseline and at the final intervention was quantified using Cohen’s d effect sizes.
Results
Nineteen MHCPs at 7 Air Force Bases, 2 Naval hospitals, and 1 Army medical center utilized the platform with 245 ADSMs presenting with insomnia (M age =32.6 + 8.0 y.o.; 27.3% women, 78% Sailors/Marines, 19% Airmen, 3% Soldiers). Average treatment duration was 5 ±1 weeks. The mean completion rate of diaries was 77% + 20%. Post-treatment, 83.5% of ADSMs met treatment response criteria, and 70.3% met remission criteria. From baseline to the last intervention, clinically meaningful improvements in SL, WASO, and %SE were observed (all Cohen’s d > .5).
Conclusion
Augmentation of CBTI capabilities among MHCP using a digital CDS platform is feasible and yields rapid and clinically meaningful improvements in sleep among ADSMs with insomnia. CDS-enabled services may facilitate the scalability of DoD/VA insomnia management practices and reduce CBTI capability gaps.
Support (if any)
MTEC-2019-406, AFMRA (29700-0007), Leidos (P010268077).