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.

This was a before-and-after service evaluation with a historical comparator, not a randomised trial, so other changes over time may have affected referrals and testing. The group who engaged with Standard Care was small, with 14 patients, so comparisons are imprecise. The new model was a bundle of triage, local testing, telehealth reporting and treatment pathways; the evaluation cannot separate the contribution of any single component. The study stopped at provision of test results and did not follow patients through treatment uptake, compliance, or health outcomes. The cost analysis was a modelled decision tree for 100 patients from the health service perspective, excluding patient out-of-pocket costs, and depends on local funding and travel subsidy arrangements. The consumer survey had 28 respondents and may not represent all patients. The reported p value for time from referral to testing was 0.48, so the shorter median time should not be treated as a statistically significant effect. The proportion of First Nations patients among those who engaged declined from 21% to 15%, although this was not statistically significant.

The study was funded by the Metropolitan Health Service. The authors were employed by the Remote Health Service and the Metropolitan Health Service.

Do not read the nine-fold referral increase or cost saving as proof that patients with sleep apnoea get better health outcomes. The study followed referrals, testing and service delivery, not treatment uptake or clinical outcomes, and it was a before-and-after service evaluation, not a randomised trial.