1317 Addressing OSA Care in Rural Communities: Development of the West Virginia OSA Academic Mentoring Partnership

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Abstract Introduction This study used implementation science and community engaged research methods to address a significant care gap for obstructive sleep apnea (OSA) in West Virginia (WV). To this end, we designed an intervention to support primary care providers (PCPs) who treat patients in rural WV. Our overall project is grounded in context-sensitive approaches to address the unique challenges of OSA management in the rural primary care setting. Here we describe the pre-implementation work that identified the determinants of implementation in rural settings and the selection of strategies that led to the initial program; these strategies will inform our prospective implementation effectiveness study. Methods We used the VA Quality and Enhancement and Research Initiative (QUERI) Implementation Roadmap to inform program development. Barriers and facilitators identified in our previous research were mapped to the domains of the Consolidated Framework for Implementation Research (CFIR) to inform our implementation plan. We derived Expert Recommendations for Implementing Change (ERIC) strategies from the CFIR mapping exercise to identify the strategies that would improve implementation outcomes in rural primary care. Results Themes identified from our previous mixed methods community engagement study with PCPs were reviewed and mapped to CFIR domains and coded as implementation barriers or facilitators. Based on this work we identified ERIC strategies that were most likely to facilitate implementation of our intervention. The implementation strategy category identified as most important for the OSA care program implementation was “Develop stakeholder interrelationships.” Other important strategy categories included “Provide interactive assistance” and “Support for clinicians” in the targeted rural communities. Conclusion Leveraging a community-engaged approach and using implementation science informed the development of a novel program to support PCPs in OSA management that is tailored to the realities of rural primary care. This program, the West Virginia Obstructive Sleep Apnea Academic Mentoring Partnership (WV OSA AMP), is well-positioned to address the care disparity for OSA in rural communities in a sustainable way. More information on WV OSA AMP is available at: https://wvrha.org/wvosaamp/. Support (if any) NIH K23 HL161437-0A1. This study was also funded but an AASM Foundation Strategic Grant (SR2332), but funding was declined by the PI due to overlap with NIH grant.

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