PCORI funds Dissemination and Implementation projects to increase awareness and promote the use of PCORI research findings to improve healthcare practices and health outcomes. This project is proposing to conduct dissemination and implementation activities for the results of the research project: Does a Peer Support Program Improve Satisfaction with Treatment among Patients with Obstructive Sleep Apnea?.
1. What research finding is this project implementing?
Treatment adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea (OSA) was improved after experienced trained patients (called “peer buddies”) helped patients with OSA who recently received CPAP therapy better use the CPAP machine. CPAP usage at six months was better in the treatment group than in the group that received written materials and educational DVDs/videos. Patients who received support from peer buddies experienced greater satisfaction for CPAP support than did patients in the control group, who received conventional education. Moreover, patients rated their care coordination as better, were less sleepy, and had lower blood pressure if they were sleepy or hypertensive when they began the study participation.
Our project tackles an important barrier in the field of sleep medicine. 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 health-related quality of life, increased all-cause mortality, and motor vehicle accidents due to sleepiness. In a recent large study, treatment of OSA with CPAP therapy improved quality of life and mood, but the effect on mortality was limited by poor CPAP adherence. The readiness and willingness to change and sustain such changes are present, as evidenced by the health plan expressing willingness to pay for these peer buddies’ time. Such sustainability makes our study ready for implementation efforts.
2. Why is this research finding(s) important?
CPAP adherence is poor, with up to 54% of patients being nonadherent to CPAP therapy by Medicare criteria; such nonadherence has been attributed to inadequate patient education and support for CPAP therapy. Poor CPAP adherence is associated with increased risk for fatal and nonfatal cardiovascular events. CPAP therapy has been associated with up to a threefold reduction in fatal and nonfatal cardiovascular events in both on-treatment analysis of randomized controlled trials and observational studies. CPAP therapy is associated with a sevenfold reduction in fatigue-related accidents. CPAP adherence—measured as proportion of nights with less than four hours of usage—is a widely accepted standard, and if this proportion were less than 70%, it could lead to loss of CPAP benefits. To save one patient from losing his or her CPAP benefit, nine patients would need to be treated with the PDI-IVR system. Such potential benefits are very patient centered and have a clinically meaningful impact.
3. What is the goal of this implementation project?
Our goal is to implement the peer buddy training through the phone exchange (called the PDI-IVR system) that was the basis for the peer-driven intervention. We will train patients with OSA who are experienced CPAP users to deliver such peer intervention. Individuals delivering the peer intervention—the peer buddies—are the vehicles of our peer-driven intervention, and they can provide educational, supportive, and behavioral education aimed at promoting CPAP adherence in patients with OSA. As part of this dissemination effort, peer buddies can train more individuals to perform this work—what we call “training the trainers.”
4. What is the project team doing?
We will develop and disseminate a training module remotely using a web-based software platform (Panopto) along with the print version of the peer buddy training manual. Additionally, we will use the IVR system (DSC Corp., Phoenix, Arizona) platform for training 120 peer buddies, who in turn will train 200 peer buddies and be responsible for improving the adherence of more than 2,000 patients in 11 centers in the Banner Healthcare System. Through such a train-the-trainers approach, we will develop a large workforce of peer educators who can promote CPAP adherence and help patients receive the full benefits of adequate CPAP therapy.
5. How is the team evaluating its implementation activities?
We will measure quality metrics data from the 11 sleep centers. Such data are routinely generated every three months and consist of the centers’ patients’ CPAP usage , blood pressure, sleepiness, knowledge of sleep apnea, satisfaction with care delivery, and healthcare utilization.
6. How is the team involving patients and others in this implementation project?
A tremendous amount of input from eight key patient stakeholder groups has gone into the development of this proposal. We will hold patient stakeholder webinar meetings every three months and one in-person meeting per year involving peer buddies and participants who had completed their study participation to discuss implementation of the project results and aspects pertaining to various available modalities for disseminating and communicating such findings. The planning was carefully weighed by patients, patient advocacy group representatives (from the American Sleep Apnea Association), policy makers (from the American Academy of Sleep Medicine), purchasers, Principal Investigators, product manufacturers, and payors.
7. How will this project help ensure future uptake and use of PCORI results?
Our previous work has led to changes in Medicare policy with regard to coverage of CPAP therapy for patients with OSA. We have experience in engaging various stakeholders to translate study findings in ways that improve patients’ health and well-being.
Learn more about PCORI’s Dissemination and Implementation program here.
Related PCORI-funded Research Project
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.