Dr. Nneka O. Mokwunye
Steering Committee Member
Dr. Evan G. DeRenzo
Respiratory Care
Unique liaisons
Did you know this NetWork has unique liaisons from the ACCP community?
Here is a brief description of these organizations with their liaisons from the ACCP:
AARC-BOMA: American Association for Respiratory Care – Board of Medical Advisors (www.aarc.org/)
The AARC is an association for respiratory care professionals and allied health specialists interested in cardiopulmonary care. The AARC is committed to enhancing professionalism of respiratory care practitioners, improving job performance, and helping to broaden the practitioners’’ scope of knowledge. The AARC publishes AARC Times and RESPIRATORY CARE.
AARC-BOMA Liaisons: Dr. Robert Aranson, FCCP; Dr. Kent L. Christopher, RRT, FCCP; Dr. Woody V. Kageler, FCCP; and Dr. Harold Manning, FCCP.
CoARC: Commission on Accreditation for Respiratory Care (www.coarc.com/)
CoARC’’s mission is to promote high quality respiratory care education through accreditation services. The CoARC accredits first professional respiratory care degree programs at the Associate, Baccalaureate, and Master Degree level in the United States and internationally and also accredits professional respiratory care degree programs in polysomnography.
CoARC Liaisons: Dr. David L. Bowton, FCCP; Dr. Joseph P. Coyle, FCCP; and Dr. Kevin M. O’’Neil, FCCP.
NAMDRC: The National Association for Medical Direction of Respiratory Care (www.namdrc.org/)
NAMDRC is a national organization of physicians whose mission is to educate its members and address regulatory, legislative, and payment issues that relate to the delivery of health care to patients with respiratory disorders. NAMDRC represents physicians in respiratory care departments, critical/ICUs, sleep labs, pulmonary rehabilitation, and managing blood gas laboratories. NAMDRC publishes Washington Watchline and Current Controversies.
NAMDRC has a representative to the ACCP Respiratory Care NetWork: Dr. Paul A. Selecky, FCCP.
NBRC: The National Board for Respiratory Care (www.nbrc.org)
The NBRC is a voluntary health certifying board that evaluates the professional competence of respiratory therapists. The NBRC strives for excellence in providing credentialing examinations and associated services to the respiratory community. The NBRC’’s CRT examination is currently the basis for state licensure for RTs in 49 states. Through its Continuing Competency Program, the NBRC demonstrates compliance with the accreditation standards of the National Commission for Certifying Agencies (NCCA).
NBRC Liaisons: Dr. Robert A. Balk, FCCP; Dr. Brian W. Carlin, FCCP (also the current NBRC Vice President); Dr. David A. Kaminsky, FCCP; Dr. Carl Kaplan, FCCP; and Dr. Robert A. May, FCCP.
Dr. Herbert Patrick, FCCP
Chair
Dr. Kevin M. O\'’Neil, FCCP
Vice-Chair
Home Care
Home sleep testing
The field of sleep medicine is evolving in multiple ways. One critical change involves the growing, and increasingly mandated, adoption of home sleep testing (HST) for the diagnosis of obstructive sleep apnea (OSA). While the technology is not new, its role in the routine diagnosis of OSA has evolved over the past decade. In a comprehensive review in 2003 by the ATS, AASM, and ACCP, HST was considered acceptable when attended, but its widespread use discouraged. A decision by Medicare to approve HST as an acceptable diagnostic modality paved the way for a more widespread adoption of HST. Recent data emerged that seemed to suggest that HST has acceptable degree of specificity and sensitivity in diagnosing OSA, but it was also clear that such results were seen only in a carefully selected and circumscribed population of patients without significant comorbidity and with high pretest probability of OSA. The broader applicability of such results is hence unclear. Advantages to HST are convenience, better patient acceptance, low barrier to deployment, and lower cost. Disadvantages include data loss, a large percentage of indeterminate study results, misdiagnosis – both false-positive and false-negative, and finally, inability to determine effects on sleep architecture, as well as diagnose comorbid sleep conditions. Important concerns regarding HST have been raised that include the lack of large outcome studies and lack of external validity. The cost effectiveness of a strategy that largely adopts HST as a diagnostic modality has also been questioned.
A clinical guidelines paper by the AASM portable monitoring task force highlights the limitations and contraindications of HST. The key elements include selecting patients with high pretest probability and excluding patients with moderate to severe pulmonary disease, neuromuscular disease, and congestive heart failure, or when other sleep disorders are either suspected or comorbid.
Issues to consider as one incorporates an HST strategy include selecting the appropriate equipment and outlining an appropriate triage and distribution plan that includes an appropriate chain of custody. A recent paper from the AASM, published in the Journal of Clinical Sleep Medicine, categorizes the different systems on the basis of a SCOPER system, to enable a ready comparison of the features across different systems. Factors that need to be considered would include costs, not only of the equipment itself, but more importantly of the disposables, as well as data management and software integration with your existing platform.