Predictive Analytics and Peer-Driven Intervention for Guideline-based Care for Sleep Apnea

Obstructive Sleep Apnea Clinical Trial

Official title:

Predictive Analytics and Peer-Driven Intervention for Guideline-based Care for Sleep Apnea

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT03345524
• Other study ID #: 1709834717
• Secondary ID: 1R56HL138377-01
• Status: Not yet recruiting
• Phase: N/A
• First received: November 13, 2017
• Last updated: November 15, 2017
• Start date: November 17, 2017
• Est. completion date: October 11, 2018

Study information

• Verified date: November 2017
• Source: University of Arizona
• Contact: Sairam Parthasarathy, MD
• Phone: 520-626-6109
• Email: sparthasarathy[@]deptofmed.arizona.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 145
• Est. completion date: October 11, 2018
• Est. primary completion date: October 11, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 21 Years to 85 Years

Eligibility

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

Related Conditions & MeSH terms

• Apnea
• Obstructive Sleep Apnea
• Sleep Apnea Syndromes
• Sleep Apnea, Obstructive

Intervention

Other:
• Peer-Buddy System
2-4 30-minute in person sessions with Peer Buddy (2 before and 2 after receiving CPAP) Standard of care CPAP educational training 8-10 phone conversations with Peer Buddy over 3 month period Subsequent 3 months use of phone system to contact Peer Buddy as needed
• Usual Care
Standard of care CPAP educational training Educational Brochures and DVD videos mailed to participants (12 times)

Locations

Country	Name	City	State
United States	University of Arizona	Tucson	Arizona

Sponsors (2)

Lead Sponsor	Collaborator
University of Arizona	National Heart, Lung, and Blood Institute (NHLBI)

Country where clinical trial is conducted

United States, 

References & Publications (23)

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* Note: There are 23 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Functional Outcomes of Sleep Questionnaire (FOSQ)	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. Change in FOSQ over time will be assessed.	Baseline, Day 90, and Day 180
Other	Epworth Sleepiness Scale	This scale measure daytime sleepiness. A measure of sleepiness that is administered as 8-item questionnaire of situational sleepiness on a 3-point scale. The sum of the points will yield the Epworth score which ranges from 0 to 24 and is essentially the sum of the scores for each of the 8-items that are scored from a range of 0 to 3. An Epworth Sleepiness Score that is greater than 10 is considered to signify excessive daytime sleepiness with a score of 24 signifying with worst possible score. The change in ESS over time will be measured.	Baseline, Day 90, and Day 180
Other	Systolic Blood Pressure	Measured by experienced staff following international guidelines. Change in blood pressure over time will be assessed.	Baseline, Day 90, and Day 180
Other	Diastolic blood pressure	Measured by experienced staff following international guidelines. Change in blood pressure over time will be assessed.	Baseline, Day 90, and Day 180
Other	Body Mass Index (BMI)	A measure of body fat based on height and weight. Change in BMI over time will be assessed.	Baseline, Day 90, and Day 180
Primary	Proportion of patients undergoing sleep study testing	Difference between the proportion of patients in the peer-buddy arm from the proportion of patients in the conventional educational arm that follow-through and undergo sleep study testing.	Baseline
Secondary	CPAP Adherence downloads	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. Change in CPAP adherence over time will be assessed.	Day 30, Day 90, and Day 180