Overview
Initiative type
Service Improvement
Status
Deliver
Published
June 2025
Summary
This project entails a controlled before-and-after implementation outcome study for the delivery of sleep disorder services to a remote Australian community using the RE-AIM framework.
Dates: 2023 -
Implementation sites: The Prince Charles Hospital
Partnerships: School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology
Aim
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.
Outcomes
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).
Background
A 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.
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, two-years pre-implementation and one-year post-implementation.
Design: Controlled before-and-after implementation outcome study.
Discussion
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.
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.
References
1. Lim DC, Najafi A, Afifi L, Bassetti C, Buysse DJ, Han F, et al. The need to promote sleep health in public health agendas across the globe. Lancet Public Health. 2023;8(10):e820-e6.
2. Sleep Health Foundation. Rise and try to shine: The social and economic cost of sleep disorders in Australia. 2021.
Key contact
Irene Szollosi
Clinical Measurement Director, Sleep Disorders Centre
Metro North Hospital and Health Service