Predictive Analytics and Peer-Driven Intervention for Guideline-based Care for Sleep Apnea
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Insomnia Sleep Studies, Pulmonary, Pulmonary |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 21 - 85 |
| Updated: | 11/19/2017 |
| Start Date: | November 17, 2017 |
| End Date: | October 11, 2018 |
| Contact: | Sairam Parthasarathy, MD |
| Email: | sparthasarathy@deptofmed.arizona.edu |
| Phone: | 520-626-6109 |
Obstructive sleep apnea (OSA) is a prevalent condition that affects 7 to 12% of the US
population and is characterized by repetitive collapse of the upper airway during sleep.
Continuous positive airway pressure (CPAP) has been shown to be highly effective in the
treatment of OSA, however, adherence is poor with up to 54% of patients being non-adherent to
CPAP therapy by Medicare criteria, which has been attributed to inadequate patient education
and support for CPAP therapy.
Poor treatment adherence in patients with OSA can lead to adverse health consequences, poor
quality of life, and patient dissatisfaction. Poor treatment adherence may be due to lack of
sufficient patient education, time delays in delivery of care, lack of adequate healthcare
coordination, or difficulty accessing various healthcare providers across a front desk which
serves as a "healthcare bottle-neck". Better efficiency in healthcare delivery, with greater
connectivity through knowledgeable and trained peer volunteers and cheap cell-phones
integrated by a smart telephone exchange may alleviate some of the care and communication
burden faced by the healthcare system. Specifically, such community health education
volunteers ("peer-buddies") who are experienced in managing their OSA may be able to impart
knowledge and confidence to a recently diagnosed patient in a much more personalized manner
than that of a group therapy session.
population and is characterized by repetitive collapse of the upper airway during sleep.
Continuous positive airway pressure (CPAP) has been shown to be highly effective in the
treatment of OSA, however, adherence is poor with up to 54% of patients being non-adherent to
CPAP therapy by Medicare criteria, which has been attributed to inadequate patient education
and support for CPAP therapy.
Poor treatment adherence in patients with OSA can lead to adverse health consequences, poor
quality of life, and patient dissatisfaction. Poor treatment adherence may be due to lack of
sufficient patient education, time delays in delivery of care, lack of adequate healthcare
coordination, or difficulty accessing various healthcare providers across a front desk which
serves as a "healthcare bottle-neck". Better efficiency in healthcare delivery, with greater
connectivity through knowledgeable and trained peer volunteers and cheap cell-phones
integrated by a smart telephone exchange may alleviate some of the care and communication
burden faced by the healthcare system. Specifically, such community health education
volunteers ("peer-buddies") who are experienced in managing their OSA may be able to impart
knowledge and confidence to a recently diagnosed patient in a much more personalized manner
than that of a group therapy session.
OSA affects 7 to 12% of the US population and is an independent risk factor for several
clinical consequences such as systemic hypertension, cardiovascular disease, stroke, reduced
HR-QOL, increased all-cause mortality, and motor vehicle accidents due to sleepiness.
However, OSA and other sleep disorders are woefully underdiagnosed because of time
constraints at the PCP's office. Such poor CPAP adherence is associated with increased risk
for fatal and non-fatal cardiovascular events. CPAP therapy has been associated with up to
3-fold reduction in fatal and non-fatal cardiovascular events in both on-treatment analysis
of RCTs and observational studies. CPAP therapy is associated with 7-fold reduction in
sleepiness-related accidents. The overarching aim of this proposal is to institute a
multi-level strategy aimed at improving guideline based care for OSA in populations with
health disparities.
The overarching aim of the program of research is to eventually institute a multi-level
strategy with interventions aimed at both providers and patients in order to improve
guideline based care for OSA in populations with health disparities. Specifically, in order
to address the under-diagnosis of OSA, an electronic health record (EHR) based predictive
analytics system will be implemented. A similar EHR-based alert system with reflex order sets
for initiating testing for OSA that the investigators have developed will enable PCPs to
effectively diagnose and treat OSA. It was found that in a nationally representative dataset
of ~220,000 patients, lower neighborhood income was associated with lower CPAP adherence.
Considering the time and access-related barriers in the PCP office, it is believed that such
socioeconomic status (SES) related differences in CPAP adherence needs to be addressed by
culturally-competent peer educators (such as promotors) with OSA serving as "peer-buddies".
In a recent multi-site RCT, it was found that CPAP adherence and patient satisfaction was
improved by peer-driven intervention through an interactive voice response system (PDI-IVR;
PCORI-IHS-1306-02505), whereby the peers shared their experiences with CPAP naïve patients
and educated them about OSA and risks of CPAP nonadherence. Whether PDI-IVR can improve
adherence in underserved population in low resource clinics is unclear. In this proposal, 110
CPAP naïve patients and 35 experienced peer-buddies will be recruited in from a large
healthcare system that provides care for an underserved population with an excess burden of
sleep disorders (Medicaid and dual-eligible Medicare beneficiaries). This study will address
health disparities in the diagnosis and treatment of OSA using a patient-level educational
intervention (PDI-IVR system) targeting patients and thereby promote health equity. This
proposal will also inform future studies by gathering additional data on the effect of
PDI-IVR on adherence to sleep study testing and CPAP adherence in an underserved population
in low resource clinics.
Specific Aim #1: To test a peer-driven intervention with interactive voice response (PDI-IVR)
system to improve adherence to sleep study testing in a lower socioeconomic population.
Hypothesis #1: A PDI-IVR support system will lead to greater adherence to sleep study testing
in patients with OSA when compared to patients receiving conventional education.
Specific Aim #2: To test a peer-driven intervention with interactive voice response (PDI-IVR)
system to improve CPAP treatment adherence in a lower socioeconomic population.
Hypothesis #2: A PDI-IVR support system will lead to greater adherence to CPAP therapy in
patients with OSA when compared to patients receiving conventional education.
clinical consequences such as systemic hypertension, cardiovascular disease, stroke, reduced
HR-QOL, increased all-cause mortality, and motor vehicle accidents due to sleepiness.
However, OSA and other sleep disorders are woefully underdiagnosed because of time
constraints at the PCP's office. Such poor CPAP adherence is associated with increased risk
for fatal and non-fatal cardiovascular events. CPAP therapy has been associated with up to
3-fold reduction in fatal and non-fatal cardiovascular events in both on-treatment analysis
of RCTs and observational studies. CPAP therapy is associated with 7-fold reduction in
sleepiness-related accidents. The overarching aim of this proposal is to institute a
multi-level strategy aimed at improving guideline based care for OSA in populations with
health disparities.
The overarching aim of the program of research is to eventually institute a multi-level
strategy with interventions aimed at both providers and patients in order to improve
guideline based care for OSA in populations with health disparities. Specifically, in order
to address the under-diagnosis of OSA, an electronic health record (EHR) based predictive
analytics system will be implemented. A similar EHR-based alert system with reflex order sets
for initiating testing for OSA that the investigators have developed will enable PCPs to
effectively diagnose and treat OSA. It was found that in a nationally representative dataset
of ~220,000 patients, lower neighborhood income was associated with lower CPAP adherence.
Considering the time and access-related barriers in the PCP office, it is believed that such
socioeconomic status (SES) related differences in CPAP adherence needs to be addressed by
culturally-competent peer educators (such as promotors) with OSA serving as "peer-buddies".
In a recent multi-site RCT, it was found that CPAP adherence and patient satisfaction was
improved by peer-driven intervention through an interactive voice response system (PDI-IVR;
PCORI-IHS-1306-02505), whereby the peers shared their experiences with CPAP naïve patients
and educated them about OSA and risks of CPAP nonadherence. Whether PDI-IVR can improve
adherence in underserved population in low resource clinics is unclear. In this proposal, 110
CPAP naïve patients and 35 experienced peer-buddies will be recruited in from a large
healthcare system that provides care for an underserved population with an excess burden of
sleep disorders (Medicaid and dual-eligible Medicare beneficiaries). This study will address
health disparities in the diagnosis and treatment of OSA using a patient-level educational
intervention (PDI-IVR system) targeting patients and thereby promote health equity. This
proposal will also inform future studies by gathering additional data on the effect of
PDI-IVR on adherence to sleep study testing and CPAP adherence in an underserved population
in low resource clinics.
Specific Aim #1: To test a peer-driven intervention with interactive voice response (PDI-IVR)
system to improve adherence to sleep study testing in a lower socioeconomic population.
Hypothesis #1: A PDI-IVR support system will lead to greater adherence to sleep study testing
in patients with OSA when compared to patients receiving conventional education.
Specific Aim #2: To test a peer-driven intervention with interactive voice response (PDI-IVR)
system to improve CPAP treatment adherence in a lower socioeconomic population.
Hypothesis #2: A PDI-IVR support system will lead to greater adherence to CPAP therapy in
patients with OSA when compared to patients receiving conventional education.
Inclusion Criteria for Subject:
- Referral for sleep study testing for possible OSA
- Medicaid and dual-eligible Medicare beneficiaries
- Household income in the bottom national quartile of household median income
Inclusion Criteria for Peer Buddy:
- Adherent to CPAP therapy (greater than or equal to 4 hours per night of CPAP use)
- Willing to meet with peer-buddy on 2-4 occasions in-person
- Has a cell phone or other reliable telephone line
- Willing to undergo one-two training and orientation session(s) and pass a subsequent
mock patient interaction
Exclusion Criteria for Subject:
- Central sleep apnea (CSA)
- Participation in another intervention-based research study
- Patient's primary care provider refuses patient participation for medical instability
Exclusion Criteria for Peer Buddy:
- Central sleep apnea (CSA)
- Participation in another intervention-based research study
- Patient's primary care provider refuses patient participation for medical instability
- Major depression or other major psychiatric illness
- Shift-worker or frequent out of town traveler
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