# Resilience in Health Care: The Role of Telemedicine and e-Health Enabling Adaptive Strategies in Sleep Medicine Practice During the COVID-19 Pandemic

## TL;DR

This paper shows how a sleep medicine practice adapted to the pandemic using telemedicine and e-health, maintaining care and expanding access.

## Contribution

The study highlights how telemedicine and adaptive strategies enabled resilience in sleep medicine during the pandemic.

## Key findings

- Telemedicine visits increased significantly during the post-acute phase of the pandemic.
- Home sleep apnea tests rose sharply while polysomnography use decreased.
- Patient demographics shifted, with more younger, female, non-White, and postgraduate-educated patients served.

## Abstract

The COVID-19 pandemic brought profound changes to health care systems worldwide. This study examines the adaptive responses of a sleep medicine practice that successfully pivoted to telemedicine, remote diagnostics, and agile operations, resulting in sustained growth and improved patient accessibility.

We analyzed organizational and cultural elements enabling responsiveness, including telemedicine infrastructure, adaptive leadership, quality-focused processes, and effective communication. Objective outcomes were assessed by analyzing patient demographics, telemedicine visits, and sleep testing patterns during three phases: pre-pandemic (June 1, 2018 to March 8, 2020), acute COVID-19 (March 9, 2020 to April 19, 2020), and post-acute COVID-19 (April 20, 2020 to December 31, 2021).

Across 105,199 encounters, monthly sleep medicine visits and testing declined ∼50% during acute COVID-19, but rebounded to surpass baseline in the post-acute phase. Virtual visits increased significantly, replacing many face-to-face encounters. Home sleep apnea test use rose sharply, driven by disposable WatchPAT tests, while polysomnography use decreased. Testing volumes increased overall post-acute compared with pre-pandemic. Patients served during acute and post-acute phases were younger, more often female, non-White, and postgraduate-educated (all p < 0.001). Nonlocal patients increased during the post-acute phase, reflecting telemedicine expansion.

Proactive telemedicine investments, adaptive leadership, quality-focused processes, and effective communication enabled this practice to adapt successfully during the pandemic. These resilience strategies provide a model for navigating future health care challenges, underscoring telemedicine and e-health’s critical roles in maintaining care delivery during crises.