The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients’ Satisfaction, and Outcome in a Large Health Provider System

During 2009, the Haifa district of Clalit Health Services (CHS) has switched from in-lab polysomnography (PSG) to home studies for the diagnosis of obstructive sleep apnea (OSA). We assessed the effects of this change on accessibility, waiting time, satisfaction, costs, and CPAP purchase by the patients. Data regarding sleep studies, CPAP purchase, and waiting times were collected retrospectively from the computerized database of CHS. Patients’ satisfaction was assessed utilizing a telephone questionnaire introduced to a randomized small sample of 70 patients. Comparisons were made between 2007 and 2008 (in-lab PSGs) and 2010 and 2011 (when most studies were ambulatory). Of about 650000 insured individuals in the Haifa district of CHS, 1471 sleep studies were performed during 2007-2008 compared to 2794 tests during 2010-2011. The average waiting time was 9.9 weeks in 2007-2008 compared to 1.1 weeks in 2010-2011 (P<0.05). 597 CPAPs were purchased in 2007-2008 compared to 831 in 2010-2011. The overall patients’ satisfaction was similar, but discomfort tended to be higher in the in-laboratory group (4.1 vs 2.7 in a scale of 0–10; P=0.11). Switching to ambulatory diagnosis improved the test accessibility and reduced the waiting times. Patients’ satisfaction remained similarly high. The total direct cost of OSA management was reduced

La construcción del Estado en España: haciendo historia cultural de lo político

Este artículo ha sido realizado en el marco del proyecto HAR2012-32713 del Plan Nacional de I+D+i de EspañaLos estudios sobre la construcción de los estados nacionales aparecen dominados por dos paradigmas que conviene someter a discusión. Por un lado, el paradigma de la continuidad, en virtud del cual el Estado nacional contemporáneo se presenta como la culminación de un proceso iniciado con la aparición de las monarquías absolutas en los siglos XV al XVII. El otro paradigma victorioso en el acercamiento al fenómeno histórico de la construcción de estados es el del Estado fiscal (fiscal state), creado y sostenido principalmente desde la sociología históricaPeer reviewe