{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T05:16:33Z","timestamp":1780377393621,"version":"3.54.1"},"reference-count":30,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2017,11,1]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:p>Obstructive sleep apnoea (OSA) is more prevalent in patients with hypertension (HTN), and associated morbidities include stroke, heart failure and premature death. In the Internal Medicine Clinic (IMC), over 70% of the patients had a diagnosis of HTN and obesity. We identified a lack of OSA screening in patients with HTN. The aim of this quality improvement (QI) was to increase OSA diagnosis to 5% from the baseline rate of less than 1% in patients with HTN between the ages of 18 and 75 years over 6 months at IMC. We used the Plan-Do-Study-Act (PDSA) method. The QI team performed root cause analysis to identify materials\/methods, provider and patient-related barriers. PDSA cycle included: (1) integration of customised workflow of loud Snoring, Tiredness, Observed apnea, high blood Pressure (STOP)-Body mass index (BMI), Age, Neck circumference, and Gender (BANG) OSA screening tool in the electronic health record (EHR); (2) physician education of OSA and EHR workflow; and (3) completion of STOP survey by patients, which was facilitated by nursing staff. The outcome measure was the percentage of OSA diagnosis in patients with HTN. The process measures included the percentage of patients with HTN screened for OSA and the increase in sleep study referrals in hypertensive patients with STOP-BANG score of \u22653. Increase in patient wait time and cost of sleep study were the balance measures. Data analysis was performed using weekly statistical process control chart. The average increase in OSA screening rate using the STOP-BANG tool was 3.88%. The significant variation seen in relation to PDSA cycles was not sustainable. 32% of patients scored \u22653 on the STOP-BANG tool, and 10.4% had a confirmed diagnosis of OSA. STOP-BANG tool integration in the EHR and a team approach did not result in a sustainable increase in OSA screening. OSA diagnosis was increased to 3.3% in IMC patient population within the 6-month period. The team identified multiple barriers to screening and diagnosis of OSA in the IMC.<\/jats:p>","DOI":"10.1136\/bmjoq-2017-000105","type":"journal-article","created":{"date-parts":[[2017,11,25]],"date-time":"2017-11-25T20:10:11Z","timestamp":1511640611000},"page":"e000105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Improving OSA screening and diagnosis in patients with hypertension in an academic safety net primary care clinic: quality improvement project"],"prefix":"10.1136","volume":"6","author":[{"given":"Smita Y","family":"Bakhai","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansi","family":"Nigam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musa","family":"Saeed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amita","family":"Krishnan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University at Buffalo, The State University of New York, Buffalo, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,25]]},"reference":[{"key":"2025083114201870000_6.2.e000105.1","doi-asserted-by":"publisher","DOI":"10.1586\/erc.09.25"},{"issue":"Pt A","key":"2025083114201870000_6.2.e000105.2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ejphar.2015.06.024","article-title":"Obstructive sleep apnea syndrome, continuous positive airway pressure and treatment of hypertension","volume":"763","author":"Floras","year":"2015","journal-title":"Eur J Pharmacol"},{"key":"2025083114201870000_6.2.e000105.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2015.05.003"},{"key":"2025083114201870000_6.2.e000105.4","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1001\/jama.2016.20325","article-title":"Screening for obstructive sleep apnea in adults: US preventive services task force recommendation statement","volume":"317","author":"Bibbins-Domingo","year":"2017","journal-title":"JAMA"},{"key":"2025083114201870000_6.2.e000105.5","doi-asserted-by":"publisher","DOI":"10.1097\/MCP.0000000000000102"},{"key":"2025083114201870000_6.2.e000105.6","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","article-title":"Prevalence of obstructive sleep apnea in the general population: a systematic review","volume":"34","author":"Senaratna","year":"2017","journal-title":"Sleep Med Rev"},{"key":"2025083114201870000_6.2.e000105.7","doi-asserted-by":"publisher","DOI":"10.1007\/s11906-007-0095-2"},{"key":"2025083114201870000_6.2.e000105.8","unstructured":"Calculate Your BMI - Standard BMI Calculator. http:\/\/www.nhlbi.nih.gov\/health\/educational\/lose_wt\/BMI\/bmicalc.htm"},{"key":"2025083114201870000_6.2.e000105.9","unstructured":"Hypertension. https:\/\/www.cdc.gov\/nchs\/fastats\/hypertension.htm"},{"key":"2025083114201870000_6.2.e000105.10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1001\/jamaoto.2016.4720","article-title":"USPSTF recommendation for obstructive sleep apnea screening in adults","volume":"143","author":"Yaremchuk","year":"2017","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025083114201870000_6.2.e000105.11","doi-asserted-by":"crossref","first-page":"JC50","DOI":"10.7326\/ACPJC-2017-166-10-050","article-title":"Guideline: Insufficient evidence exists on screening for obstructive sleep apnea in asymptomatic adults","volume":"166","author":"Shafazand","year":"2017","journal-title":"Ann Intern Med"},{"key":"2025083114201870000_6.2.e000105.12","first-page":"123","article-title":"Screening for obstructive sleep apnea in adults","volume":"96","author":"McNellis","year":"2017","journal-title":"Am Fam Physician"},{"key":"2025083114201870000_6.2.e000105.13","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1001\/jama.2016.19635","article-title":"Screening for obstructive sleep apnea in adults: evidence report and systematic review for the US preventive services task force","volume":"317","author":"Jonas","year":"2017","journal-title":"JAMA"},{"key":"2025083114201870000_6.2.e000105.14","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-0085"},{"key":"2025083114201870000_6.2.e000105.15","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201505-0998OC"},{"key":"2025083114201870000_6.2.e000105.16","doi-asserted-by":"publisher","DOI":"10.3109\/03009734.2012.707253"},{"key":"2025083114201870000_6.2.e000105.17","doi-asserted-by":"crossref","first-page":"773","DOI":"10.5664\/jcsm.4858","article-title":"Clinical practice Guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015","volume":"11","author":"Ramar","year":"2015","journal-title":"J Clin Sleep Med"},{"key":"2025083114201870000_6.2.e000105.18","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/hr.2016.11","article-title":"Hypertension and obstructive sleep apnea","volume":"39","author":"Cai","year":"2016","journal-title":"Hypertens Res"},{"key":"2025083114201870000_6.2.e000105.19","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.5664\/jcsm.6064","article-title":"Quality measure for screening for adult obstructive sleep apnea by primary care physicians","volume":"12","author":"Aurora","year":"2016","journal-title":"J Clin Sleep Med"},{"key":"2025083114201870000_6.2.e000105.20","doi-asserted-by":"crossref","first-page":"445","DOI":"10.4236\/ojn.2013.36060","article-title":"Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care\u2014Associations with sleep complaints, depressive symptoms and global perceived health","volume":"03","author":"Brostr\u00f6m","year":"2013","journal-title":"Open J Nurs"},{"key":"2025083114201870000_6.2.e000105.21","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3109\/02813432.2012.675563","article-title":"Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients","volume":"30","author":"Brostr\u00f6m","year":"2012","journal-title":"Scand J Prim Health Care"},{"key":"2025083114201870000_6.2.e000105.22","first-page":"287","article-title":"Symptom profile of undiagnosed obstructive sleep apnoea in hypertensive outpatients in primary care: a structural equation model analysis","volume":"20","author":"Brostr\u00f6m","year":"2012","journal-title":"Qual Prim Care"},{"key":"2025083114201870000_6.2.e000105.23","doi-asserted-by":"crossref","unstructured":"Boynton G , Vahabzadeh A , Hammoud S , et al . Validation of the stop-bang questionnaire among patients referred for suspected obstructive sleep apnea. J Sleep Disord Treat Care 2013;2.doi:10.4172\/2325-9639.1000121","DOI":"10.4172\/2325-9639.1000121"},{"key":"2025083114201870000_6.2.e000105.24","doi-asserted-by":"publisher","DOI":"10.1378\/chest.15-0903"},{"key":"2025083114201870000_6.2.e000105.25","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1097\/ALN.0000000000000665","article-title":"Correlation between the stop-bang score and the severity of obstructive sleep apnea","volume":"122","author":"Chung","year":"2015","journal-title":"Anesthesiology"},{"key":"2025083114201870000_6.2.e000105.26","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes022"},{"key":"2025083114201870000_6.2.e000105.27","doi-asserted-by":"publisher","DOI":"10.1007\/s11695-013-1006-z"},{"key":"2025083114201870000_6.2.e000105.28","first-page":"226","article-title":"Claveria-fontan a, guglielmi O. validation of the *stop* and *stop bang* *questionnaire* in primary health care","volume":"21","author":"Cruces-Artero C","year":"2012","journal-title":"Journal of Sleep Research"},{"key":"2025083114201870000_6.2.e000105.29","unstructured":"Kansas TPCaO. What is a safety net clinic?."},{"key":"2025083114201870000_6.2.e000105.30","unstructured":"Health Literacy Universal Precautions Toolkit. Plan-do-study-act (PDSA) directions and examples. 2nd Edition. https:\/\/www.ahrq.gov\/professionals\/quality-patient-safety\/quality-resources\/tools\/literacy-toolkit\/healthlittoolkit2-tool2b.html"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2017-000105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T21:20:32Z","timestamp":1756675232000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2017-000105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2017,11,25]]},"published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1136\/bmjoq-2017-000105"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2017-000105","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}