Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project expanded a phone-based peer support program to help patients with sleep apnea use continuous positive airway pressure, or CPAP, machines as prescribed.

Obstructive sleep apnea is a health problem that causes the throat muscles to relax and block the airway, making breathing stop and start during sleep. Sleep apnea affects millions of people in the United States. It puts people at a high risk for fatigue, accidents, and other health problems, such as high blood pressure and heart disease.

What was the goal of this implementation project?

CPAP is a common treatment for sleep apnea. CPAP machines use a mask to give patients constant, steady air pressure while they sleep. But more than half of people don’t use CPAP machines correctly or decide not to use them at all. A PCORI-funded research study found that people in a phone-based peer support program used their CPAP machines as prescribed and were more satisfied with their treatment than those who received usual education about sleep apnea and CPAP.

This project expanded the peer support program to sleep centers in the Southwest to improve CPAP use and prevent health problems due to sleep apnea.

What did this project do?

The project team put the program in place at 11 sleep centers in Arizona and Colorado that are part of Banner Healthcare System. Patients who were starting CPAP therapy were able to take part in the program.

Patients receiving peer support could use their phone to select from a menu of prompts to:

  • Meet with a peer buddy who had sleep apnea at their sleep center.
  • Talk regularly by phone, text, or email with their peer buddy over several months.
  • Talk with members of their care team, including doctors, nurses, or sleep technicians. Patients could ask questions, request supplies, or schedule clinic visits.

The project team worked with sleep centers to adapt the phone-based system to work with centers’ record systems. The team also trained a CPAP coordinator, nurse navigator, or other staff member at each center to oversee the program and enroll eligible patients.

The project team worked with sleep center staff to train patients with experience using CPAP machines to become peer buddies. Each peer buddy received a training manual and viewed a 60-minute online training video to learn how to teach others about CPAP machines. Trained peer buddies then trained additional peer buddies to work with patients. During the project, sleep center staff used checklists and call logs to track patients’ contacts with peer buddies to make sure they were helpful to patients.

Besides working with the sleep centers, the project team partnered with the American Sleep Apnea Association, or ASAA, to train peer buddies through its nationwide network of sleep apnea support groups. These peer buddies provided peer support for patients who were using CPAP machines and taking part in sleep apnea support groups.

What was the impact of this project?

The project team put the program in place at 11 sleep centers. The team trained 480 patients to serve as peer buddies and support patients starting CPAP treatment. During the project, these peer buddies worked with 1,375 patients with sleep apnea. The average number of calls per peer buddy and patient pair was 7.1. The calls lasted an average of eight minutes. 

After six months of using the program:

  • Patients’ use of CPAP as prescribed increased from 4.5 ± 2.1 [SD] hours to 5.4 ± 1.9 [SD] hours (p<0.0001) over six months.

  • The percentage of patients whose CPAP use met Medicare payment standards increased from 62% to 74% (p<0.0001). Medicare standards require CPAP use for at least four hours per night on at least five nights of the week. Patients must meet this standard for more than 30 consecutive days over 90 days in order for Medicare to pay for CPAP.

  • 80% of patients were satisfied or very satisfied with the CPAP support they received in the program. 

Patients who did and didn’t use the program didn’t differ in blood pressure, emergency room visits, or hospital stays.

The partnership with ASAA trained 122 peer buddies using the same methods and materials as the sleep centers. These peer buddies provided support for 8,368 sleep apnea support group members. After six months of the program, support group members reported an increase in use of their CPAP as prescribed from 64% to 92%.

The project team faced several challenges during the COVID-19 pandemic. At the time, patients, patient advocacy groups, and doctors didn’t know if CPAP machines increased the risk of spreading COVID-19 through the air. As such, clinicians and patients weren’t sure if starting or continuing CPAP was safe during the pandemic. Staffing shortages and a new focus on telehealth strained resources. Sleep center staff and peer buddies were less able to support patients starting CPAP. The sleep centers also offered fewer sleep studies during this time. As a result, fewer patients started using CPAP.

Of the 11 sleep centers that took part in the project, 4 closed because of financial losses. The remaining seven centers are serving the patients who received care at the closed centers and are continuing to use the program. The ASAA is continuing the peer buddy program through its network of support groups.

More about this implementation project:

Stakeholders Involved in This Project

  • American Sleep Apnea Association

  • American Academy of Sleep Medicine

  • Arizona Medicaid program

  • An advisory board made up of patients, clinicians (physicians, sleep technicians, behavioral therapists, clinical psychologists, respiratory therapists, and registered nurses), and representatives of CPAP device manufacturers

Publicly Accessible Project Materials

  • Peer buddy training manual: Training materials developed during the project and instructions on how to use the manual

  • Peer buddy interactions video reenactment: Video reenactment of the peer-driven intervention that can be used for future implementation process

  • Web-based algorithm: Algorithm that can be customized by future sleep centers and sleep physician practices to support scale-up beyond the PCORI-funded project

  • Audit and Feedback report examples and lessons learned: Exemplars of audit and feedback and details on the process used for generating these reports during the project, including barriers, pitfalls, and facilitators 

For more information about these materials, please contact the project team at spartha1@arizona.edu.

To become a peer buddy or mentor, enroll at https://www.sleephealth.org/asaa/peer-mentors/#becomeamentor

To get support from the peer buddy program, enroll at https://www.sleephealth.org/asaa/peer-mentors/mentees/

For more information about the peer buddy program, please contact ASSA at asaa@sleephealth.org.

The project team developed these materials, which may be available for free or require a fee to access. Please note that the materials do not necessarily represent the views of PCORI and that PCORI cannot guarantee their accuracy or reliability.

Project Achievements

  • Trained 602 peer buddies to deliver the program—480 to support patients at sleep centers and 122 to support people who were members of sleep apnea support groups.
  • Reached 9,743 patients with sleep apnea—1,357 through sleep centers and 8,368 through sleep apnea support groups.
  • Demonstrated the feasibility of using the phone-based peer buddy support program in 11 clinics.
  • Created implementation resources for future sites interested in the program.
  • Continued to maintain implementation of the peer buddy program within the health system and through the American Sleep Apnea Association’s network of sleep apnea support groups following the project.

Implementation Strategies

  • Adapted in-person training for peers by transferring existing content to an online platform.

  • Adapted the peer support program to work with sites’ existing resources and workflows.

  • Used an electronic, phone-based system for implementation.

  • Provided sites with tools to support implementation, including manuals and checklists.

  • Provided educational materials to peer buddies and patients as online modules.

  • Trained sleep center staff to deliver the peer support program through a written manual and video.

  • Using a video, trained peer buddies to educate patients about the risks of untreated obstructive sleep apnea, share strategies for improving adherence, and prepare for appointments.
  • Used train-the-trainer strategies to train additional peer buddies.

  • Used a phased implementation approach.

  • Identified and prepared local champions at sleep centers, typically a CPAP coordinator or nurse navigator.

  • Provided technical assistance to sites, including consultation.

  • Used or developed payment mechanisms to facilitate implementation.

  • Promoted implementation using peer networks.

  • Partnered with national stakeholder organization to promote implementation.

Evaluation Outcomes

To document implementation:

  • Number of eligible patients who receive the peer support program
  • Fidelity of peer support interactions between peer buddies and mentees (e.g., number of interactions, consistency of support provided)

To assess healthcare and health outcomes:

  • CPAP adherence
  • Patient satisfaction
  • Blood pressure

COVID-19-Related Project Activities

PCORI supplemental funding supported project activities to address evolving or emerging needs in the context of the COVID-19 public health crisis.

For many patients with sleep apnea, the COVID-19 pandemic raised questions about the safety of CPAP machines. Also, during the pandemic, patients were not able to go to follow-up visits. As a result, patients may not have received as much support when they started using CPAP.

With the enhancement, the project team updated training materials for peer buddies to help them respond to patients’ concerns about CPAP use during the pandemic. The team then extended the peer support program through a nationwide network of more than 200 sleep apnea support groups that could reach patients directly. 

Through this enhancement, the project team trained 122 peer buddies and reached 8,368 patients nationwide. Patients taking part in the program reported a 28% increase in using CPAP as prescribed. Also, 89% reported they were satisfied or very satisfied with their support.

Enhancement Award Amount: $484,371

Project Information

Sairam Parthasarathy, MD
University of Arizona
$1,818,228

Key Dates

February 2019
April 2023
2019

Study Registration Information

Initial PCORI-Funded Research Study

This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Does a Peer Support Program Improve Satisfaction with Treatment among Patients with Obstructive Sleep Apnea?

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Last updated: May 1, 2024