Abstract: During the COVID pandemic, access to sleep therapy labs was limited, increasing waiting lists. Therefore, telemonitoring (TM), although already in use for monitoring purposes in this hospital, its use was expanded to titrate and follow patients remotely. Our aim was to measure the impact of expanded TM use on obstructive sleep apnea (OSA) pathway. Time-Driven Activity-Based Costing (TDABC) was implemented to compare previous and new pathways from patient referral to follow-up. A scorecard with patient, process and cost outcomes was developed for comparison. Healthcare professionals? time decreased by 9% (167 vs 152 minutes) with the new pathway, resulting in 8€ cost saving per patient. Process improved by decreased waiting time from 18 to 2 months and decreased discharge time from 12 to 6 months; enabling faster access to therapy. Therapy adherence improved by 10% (5.7 vs 6.3 h/day), drop-out rate decreased by 54% (8.2% vs 3.8%) and, year 1 compliance improved 15% (79% vs 91%). The TDABC approach demonstrated that expanded use of TM improved patient, process and cost outcomes, showing additional value of a digital pathway for OSA patients and providing a foundation for value-based healthcare implementation.

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