The state of Veterans Affairs sleep medicine programs: 2012 inventory results.
OBJECTIVE
The Veterans Health Administration (VHA) represents one of the largest integrated health-care systems in the country. In 2012, the Veterans Affairs Sleep Network (VASN) sought to identify available sleep resources at VA medical centers (VAMCs) across the country through a national sleep inventory.


METHODS
The sleep inventory was administered at the annual 2012 VA Sleep Practitioners meeting and by email to sleep contacts at each VAMC. National prosthetics contacts were used to identify personnel at VAMCs without established sleep programs. Follow-up emails and telephone calls were made through March 2013.


RESULTS
One hundred eleven VA medical centers were included for analysis. Thirty-nine programs did not respond, and 10 were considered "satellites," referring all sleep services to a larger neighboring VAMC. Sleep programs were stratified based on extent of services offered (i.e., in-lab and home testing, sleep specialty clinics, cognitive behavioral therapy for insomnia (CBT-i)): 28 % were complex sleep programs (CSPs), 46 % were intermediate (ISPs), 9 % were standard (SSPs), and 17 % offered no formal sleep services. Overall, 138,175 clinic visits and 90,904 sleep testing encounters were provided in fiscal year 2011 by 112.1 physicians and clinical psychologists, 100.4 sleep technologists, and 115.3 respiratory therapists. More than half of all programs had home testing and CBT-i programs, and 26 % utilized sleep telehealth.


CONCLUSIONS
The 2012 VA sleep inventory suggests considerable variability in sleep services within the VA. Demand for sleep services is high, with programs using home testing, sleep telehealth, and a growing number of mid-level providers to improve access to care.
VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111J, San Diego, CA, 92161, USA. kfsarmiento@ucsd.edu.|Division of Pulmonary & Critical Care Medicine, University of California, San Diego, La Jolla, CA, USA. kfsarmiento@ucsd.edu.
Kathleen
K
Sarmiento
VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111J, San Diego, CA, 92161, USA.|Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
John
J
Rossettie
VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111J, San Diego, CA, 92161, USA.|Department of Medicine, University of California, San Diego, La Jolla, CA, USA.
Carl
C
Stepnowsky
VA Pittsburgh Healthcare System, University Drive, Pittsburgh, PA, 15240, USA.|PACCM, UPMC - Montefiore, Pittsburgh, PA, 15213, USA.
Charles
C
Atwood
VA San Diego Healthcare System, 3350 La Jolla Village Drive, 111J, San Diego, CA, 92161, USA.
Alan
A
Calvitti
D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008889:Military Personnel / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000175:diagnosis* / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
Access to health care; Health services; Sleep disorders; Veterans