Peer-Driven Intervention for Sleep Apnea (PCORI)
Fragmentation of care can lead to poor treatment adherence in patients with chronic medical conditions which can, in turn, 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 inexpensive 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 disease condition 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. An additional important advantage is the peer-buddy's ability to relate to the patient in a manner consistent with their social, ethnic, and cultural believes without language barriers or differences that may stem from socioeconomic strata. We will use sleep apnea as an example condition to test the effect of a peer-buddy helper (combined with the universal availability of personal cell phones) on the problem of poor care coordination and treatment adherence to the "CPAP" treatment for sleep apnea. Sleep apnea is a very common condition that affects 7-12% of the US population, and if left untreated, can lead to poor health and even death through its effects on high blood pressure, heart disease, stroke, and motor vehicle accidents. Fortunately, CPAP therapy can lead to a 3-fold reduction in such consequences, but patient adherence to such CPAP treatment is generally poor. We have recently completed a small study that demonstrated improved usage of CPAP treatment by patients receiving help from a peer-buddy with excellent results. We propose to further enhance the "peer-buddy" community-volunteer concept in our proposed research by combining this with cell-phone technology and a telephone exchange that improves access to healthcare providers, technicians, and home care companies. We hope to show that active community participation by experienced "lay individuals" assisted by the universal availability of cheap cell-phones can improve the reach and effectiveness of our healthcare system in improving the health and well-being of our patients. If successful, such an innovative and community-based approach can be applied to other chronic medical conditions.
Hypothesis #1: We hypothesize that patients in the peer-driven intervention with interactive voice response (PDI-IVR) group will experience a greater patient satisfaction (measured by Likert scale64,70 and PACIC71,72) and perception of care coordination (measured by CPCQ72,73) than patients in the usual care (control) group.
Hypothesis #2: We hypothesize that patients in the PDI-IVR group will experience a greater CPAP adherence (measured by device download), patient activation (PAM), and self-efficacy (SEMSA) than patients in the usual care (control) group.
Hypothesis #3: We hypothesize that patients in the PDI-IVR group will experience greater improvements in HR-QOL (measured by FOSQ) vigilance (psychomotor vigilance testing) and blood pressure than patients in the usual care (control) group.
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: No masking
Primary Purpose: Supportive Care
|Official Title:||Peer-Driven Intervention as an Alternate Model of Care Delivery and Coordination for Sleep Apnea|
- Patient rating of sleep-specific services (Usual Care, Peer Buddy System) [ Time Frame: Day 180 ]Patients will rate their global satisfaction of how satisfied they are with the care received from their sleep physician and sleep center on a 5-point scale: very satisfied, satisfied, neutral, dissatisfied, very dissatisfied
- Patient Assessment of Care for Chronic Conditions (PACIC) ( Usual Care, Peer Buddy System) [ Time Frame: Day 180 ]Derived from AHRQ care coordination measures atlas, measures care that is patient-centered, includes collaborative goal setting; problem-solving and follow-up support within the past 6 months and consists of five sub scales addressing the patient activation, delivery system design, goal setting, problem solving, and follow-up/coordination.
- Client perception of care coordination (CPCQ) (Usual Care, Peer Buddy System) [ Time Frame: Day 180 ]A measure of coordination of health care from the AHRQ care coordination measures atlas that is useful for assessment and program evaluation of individual and provider units as well as research into patient experience and measurement of patient-focused care.
- Consumer Assessment of Health Plans Survey (CAHPS v4.0) item (Usual Care, Peer Buddy System) [ Time Frame: Day 180 ]Health plan member's satisfaction with care on 0 to 10 scale (0 is the "worst " and 10 is the "best health plan possible")
- CPAP Adherence downloads (Peer Buddy System) [ Time Frame: Day 30, Day 90, Day 180 ]All CPAP devices have internal adherence monitoring which can be downloaded using a computer cable, smart card, SD chip or wireless transmission. The objective, adherence information as 'mask-on' time for 6 months, number of nights used, cumulative hours used, average hours of CPAP use per night, and average number of hours per day of CPAP use will be derived. The proportion of days in which CPAP use was at least 4 hr (Medicare criterion) will also be utilized.
- Patient Activation Measure (PAM) (Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management
- Self-efficacy measure for sleep apnea (SEMSA) ( Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]SEMSA is a tool with strong psychometric properties and has the potential for identifying patient perceptions that may indicate those most likely to not adhere to treatment. There are 3 domains that contribute to global score: (a) Measure of perceived risk is rated on a 4-point scale ranging from very low to very high. (b) Outcome expectancies are surveyed by a 4-point scale seeking responses (ranging from not at all true to very true) to statements of potential general outcomes if CPAP is or was not used. (c) Self-efficacy, or the volition to use CPAP therapy, is evaluated by asking the respondent to rate on a 4-point scale the level of validity (ranging from 'not at all true' to 'very true') of statements regarding their confidence in using CPAP.
- Functional Outcomes of Sleep Questionnaire (FOSQ) ( Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]A condition-specific functional status measure designed to evaluate the impact of disorders of excessive sleepiness on activities of daily living. Lower global scores are associated with greater dysfunction. FOSQ has good to excellent test-retest reproducibility, internal consistency, with discriminate validity between those seeking medical attention for sleep disorders compared to normal subjects.
- Psychomotor vigilance task (PVT) (Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]PVT is a "video game" measure of an individual's (vigilance) readiness to detect and respond to certain specified small changes in a labile environment, conceptualized pragmatically within a visio-reactive framework. Essentially, a stop clock is set at zero and begins to suddenly and spontaneously run at various time points in multiple (5) trials. As soon as the subject notices the clock start to run, they click a button that registers their reaction time. The average reaction time to such multiple runs is calculated as a inverse function of the subjects' reaction time. A practice session is afforded before the real test is administered. This takes 5 minutes time.
- Systolic and diastolic blood pressure (Peer buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]measured by experienced staff following international guidelines.
- Epworth sleepiness questionnaire ( Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]A measure of sleepiness.
- Driving Questionnaire (Usual Care, Peer Buddy System) [ Time Frame: Baseline, Day 180 ]Questionnaire regarding driving habits for patients with sleep apnea. If a motor vehicle accident was reported will need to provide documentation.
- Body Mass Index (BMI) (Usual Care, Peer Buddy System) [ Time Frame: Baseline ]A measure of body fat based on height and weight.
- Patient Ratings Survey (Usual Care, Peer Buddy System) [ Time Frame: Day 180 ]Satisfaction survey of care delivery compared between intervention and usual care.
- Hospital Re-admission (Usual Care, Peer Buddy System) [ Time Frame: Baseline, Day 90, Day 180 ]Monitor hospital re-admission in both intervention and usual care arms.
|Study Start Date:||January 2014|
|Estimated Study Completion Date:||August 2017|
|Estimated Primary Completion Date:||August 2017 (Final data collection date for primary outcome measure)|
Active Comparator: Usual Care
Other: Usual Care
- Standard CPAP educational trainingOther: Usual Care
- Educational BrochuresOther: Usual Care
- Educational DVD videos mailed to participant
Experimental: Peer-Buddy System
One Month Visit:
-Home visit to collect CPAP information
Three Month Visit:
Six Month Visit:
Other: Peer-Buddy System
One Month Visit:
- Home visit to collect CPAP information
Three Month Visit:
Six Month Visit:
Other Name: Peer-Driven Intervention
Show Detailed Description
Please refer to this study by its ClinicalTrials.gov identifier: NCT02056002
|United States, Arizona|
|University of Arizona Center for Sleep Disorders|
|Tucson, Arizona, United States, 85724|
|Principal Investigator:||Sairam Parthasarathy, MD||University of Arizona|