The Veterans Health Administration (VHA) cares for many veterans with sleep disorders who live in rural areas. VHA’s Office of Rural Health funded the TeleSleep Enterprise-Wide Initiative (EWI) to improve access to sleep care for rural veterans through creation of national telehealth networks.

The TeleSleep EWI consists of 1) Virtual synchronous care, 2) Home sleep apnea testing and 3) REVAMP (Remote Veterans Apnea Management Platform), a patient and provider-facing web application that enabled veterans to actively engage with their sleep care and sleep care team. The TeleSleep EWI was designed as a hub and spoke model, where larger sites with established Sleep centers care for smaller, rural sites with as shortage of providers. Structured formative evaluation for the TeleSleep EWI is supported by VHA’s Quality Enhancement Research Initiative and was critical in assessing outcomes and effectiveness of the program.

The TeleSleep EWI launched with 7 hubs and 34 spokes (2017) and rapidly expanded to 13 hubs and 63 spokes (2020). The TeleSleep EWI resulted in a significant increase in rural veterans accessing sleep care by utilizing home sleep apnea testing to establish a diagnosis of obstructive sleep apnea and virtual care for follow up. Rates of virtual care utilization were greater in hubs and spokes participating in the TeleSleep EWI compared with non EWI sleep programs. Additionally, veterans expressed satisfaction with their virtual care TeleSleep experiences.

The TeleSleep EWI successfully increased sleep care access for rural veterans, promoted adoption of virtual care services, and resulted in high patient satisfaction.