Evaluation of a Hub-And-Spoke Model of Care for the Delivery of Sleep Disorder Services to a Remote Australian Community Using the RE-AIM Framework: A Controlled Before-And-After Implementation Outcome Study

IF 1.9 4区医学 Q2 NURSING

Australian Journal of Rural Health Pub Date : 2025-05-18 DOI:10.1111/ajr.70057

Irene Szollosi, Sophia Worley, Sameera Senanayake, Sanjeewa Kularatna, Deanne Curtin

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引用次数: 0

Abstract

Objectives

To evaluate a Hub-and-Spoke design for providing sleep disorder services in a very remote community. The health service re-design aimed to provide unattended polysomnography at the Spoke site with access to attended laboratory studies at the Hub when clinically indicated.

Methods

Summative evaluation using the RE-AIM Framework including all adult patients referred for diagnosis and management of a suspected sleep disorder from Remote Health Service to Metropolitan Health Service 2 years pre-implementation and 1 year post-implementation.

Design

Controlled before-and-after implementation outcome study.

Setting

Public hospital in metropolitan South-East Queensland with a comprehensive accredited sleep disorder service (Hub), networked to a Community Health Centre (Spoke), located in a very remote region defined by the Modified Monash Model in central Queensland.

Main Outcomes Measures

Referral numbers (Reach), travel avoidance and consumer satisfaction (Effectiveness), number of referrers (Adoption), unattended sleep study data quality, timeliness to testing, health service costs (Implementation), and referral numbers beyond initial 12-month pilot (Maintenance).

Results

The Hub-and-Spoke model increased adoption five-fold by local referrers and resulted in a nine-fold increase in reach. Effectiveness was demonstrated through high levels of consumer satisfaction, and all implementation aims were met, including providing services at a lower cost. Sustainability was demonstrated through ongoing referrals and the transition of the model of care to business as usual.

Conclusion

Hub-and-Spoke designs for public sleep disorder services are effective at both the individual and organisational levels. Services can be delivered at a lower cost and, importantly, improve access to specialist services in remote and very remote communities.

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使用RE-AIM框架对澳大利亚偏远社区提供睡眠障碍服务的中心-辐式护理模式的评估：一项控制的前后实施结果研究

目的评价中心辐射式设计在偏远社区提供睡眠障碍服务的效果。卫生服务重新设计的目的是在Spoke站点提供无人值守的多导睡眠图，并在临床需要时在Hub提供有人值守的实验室研究。方法采用RE-AIM框架对实施前2年和实施后1年从远程卫生服务中心转到城市卫生服务中心诊断和处理疑似睡眠障碍的所有成人患者进行总体性评价。设计实施前后对照结果研究。在昆士兰州东南部市区设立公立医院，提供全面的经认证的睡眠障碍服务（Hub），与位于昆士兰州中部一个由改进莫纳什模式界定的非常偏远地区的社区卫生中心（Spoke）联网。主要结果指标：推荐人数（Reach）、避免旅行和消费者满意度（有效性）、推荐人数（采用）、无人值守睡眠研究数据质量、检测及时性、医疗服务成本（实施）和超过最初12个月试点的推荐人数（维护）。结果轮辐模式增加了当地推荐人的5倍采用率，并导致覆盖范围增加了9倍。通过消费者的高满意度证明了有效性，并实现了所有实施目标，包括以较低的成本提供服务。通过持续的转诊和护理模式向正常业务的转变，可持续性得到了证明。结论中心辐射式设计在个体和组织层面都是有效的公共睡眠障碍服务。可以以较低的成本提供服务，重要的是，可以改善偏远和非常偏远社区获得专家服务的机会。

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来源期刊

Australian Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

2.30

自引率

16.70%

发文量

122

审稿时长

12 months

期刊介绍： The Australian Journal of Rural Health publishes articles in the field of rural health. It facilitates the formation of interdisciplinary networks, so that rural health professionals can form a cohesive group and work together for the advancement of rural practice, in all health disciplines. The Journal aims to establish a national and international reputation for the quality of its scholarly discourse and its value to rural health professionals. All articles, unless otherwise identified, are peer reviewed by at least two researchers expert in the field of the submitted paper.