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

基于指南的睡眠呼吸暂停护理的预测分析和同伴驱动干预

• 批准号: 9565800
• 负责人: Sairam Parthasarathy
• 金额: $ 76.27万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-25 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9565800
• 关键词: Academy; Accidents; Address; Adherence; Adopted; Adoption; Affect; American; Arizona; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Client satisfaction; Clinic; Clinical Practice Guideline; Clinical Treatment; Computers; Continuous Positive Airway Pressure; County; Data; Data Set; Diagnosis; Drowsiness; Education; Educational Intervention; Educational Status; Electronic Health Record; Event; Gold; Guidelines; Healthcare Systems; Hospitals; Income; Individual; Institutes; Intervention; Lead; Low income; Medicaid; Medical; Medicare; Medicine; Methods; Moods; Myocardial Infarction; Neighborhoods; Observational Study; Obstructive Sleep Apnea; Outcome; Patients; Physicians' Offices; Population; Predictive Analytics; Primary Care Physician; Protocols documentation; Provider; Quality of life; Randomized Controlled Trials; Recruitment Activity; Reflex action; Resources; Risk; Risk Factors; Sepsis; Site; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Socioeconomic Status; Stroke; Support System; System; Systemic hypertension; Testing; Time; Training; Underserved Population; Voice; base; beneficiary; blood pressure reduction; clinical care; dual eligible; evidence base; experience; health disparity; health equity; health related quality of life; improved; low socioeconomic status; mortality; peer; response; tool; treatment adherence; vehicular accident

Obstructive sleep apnea (OSA) affects 12% of the US population and is associated with cardiovascular disease, reduced health-related quality of life (HR-QOL), increased all-cause mortality. However, nearly 80% of patients with OSA remain undiagnosed [QUALITY GAP #1]. Moreover, adequate adherence to continuous positive airway pressure (CPAP) therapy can improve HR-QOL and mood but the beneficial effects on cardiovascular outcomes are limited by poor CPAP adherence with nearly 54% of patients being non-adherent to CPAP therapy [QUALITY GAP #2]. The American Academy of Sleep Medicine (AASM) released evidence- based clinical practice guidelines and quality metrics for the improved diagnosis and treatment of OSA, but these have not been implemented in underserved populations. The overarching aim of this proposal is to 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, we will implement an electronic health record (EHR) based predictive analytics system that is similar to recently implemented early warning system that triggers guideline-based treatment of sepsis in hospitalized patients. The proposed EHR-based alert with reflex order sets will enable primary care physicians (PCPs) to adopt the AASM guidelines for diagnosing OSA. In approximately 220,000 patients we have found that lower neighborhood income is associated with lower CPAP adherence. Considering the time and access- related barriers in the PCP office, we believe that such health disparities in CPAP adherence need to be addressed by culturally-competent peer educators with OSA serving as “peer-buddies”. In a recent study we found that CPAP adherence can be improved by a peer-driven intervention through an interactive voice response system (PDI-IVR). Whether PDI-IVR can improve adherence in underserved populations in low resource clinics is unclear. Specific Aim #1: To test an EHR-based tool to alert primary care physicians of the potential for OSA in order to improve the diagnosis of OSA in low resource clinics. Specific Aim #2: To test a peer-driven intervention with interactive voice response (PDI-IVR) system to improve treatment adherence in populations with health disparities. Specific Aim #3: To evaluate the dissemination and implementation of a multi-level intervention strategy aimed at improving the diagnosis and treatment of OSA in populations with health disparities. We are proposing a RCT that recruits 102 providers, 362 patients, and 50 experienced peer-buddies in an underserved population with an excess burden of sleep disorders (Medicaid and dual- eligible Medicare beneficiaries in Pima county, Arizona) that is aimed at addressing the health disparities in the diagnosis and treatment of OSA. We will use a systems-level intervention (EHR-based tool) that targets providers and a patient-level educational intervention (PDI-IVR system) that targets patients in order to increase delivery of guideline-based care to populations with health disparities and promote health equity.

阻塞性睡眠呼吸暂停 (OSA) 影响 12% 的美国人口，并且与心血管疾病相关 疾病、健康相关生活质量 (HR-QOL) 下降、全因死亡率增加。然而，近 80% OSA 患者仍未得到诊断[质量差距#1]。此外，充分坚持持续 气道正压通气 (CPAP) 治疗可以改善 HR-QOL 和情绪，但其有益效果 心血管结局因 CPAP 治疗依从性差而受到限制，近 54% 的患者不依从 CPAP 治疗 [质量差距 #2]。美国睡眠医学会（AASM）公布证据—— 基于临床实践指南和质量指标来改进 OSA 的诊断和治疗，但是 这些措施尚未在服务不足的人群中得到实施。该提案的总体目标是 制定针对提供者和患者的多层次干预策略，以改善 对存在健康差异的人群进行基于指南的 OSA 护理。具体来说，为了解决以下问题 诊断 OSA 后，我们将实施基于电子健康记录 (EHR) 的预测分析系统 类似于最近实施的早期预警系统，该系统触发基于指南的脓毒症治疗 住院病人。拟议的基于 EHR 的警报和反射命令集将使初级保健医生能够 (PCP) 采用 AASM 指南来诊断 OSA。 我们在大约 220,000 名患者中发现 较低的社区收入与较低的 CPAP 依从性相关。考虑到时间和交通—— 由于 PCP 办公室存在相关障碍，我们认为 CPAP 依从性方面的这种健康差异需要得到解决 由具有文化能力的同伴教育者进行演讲，OSA 作为“同伴伙伴”。 在最近的一项研究中我们 发现通过交互式语音进行同伴驱动的干预可以提高 CPAP 的依从性 响应系统（PDI-IVR）。 PDI-IVR 是否可以提高低收入地区服务不足人群的依从性 资源诊所尚不明确。具体目标#1：测试基于 EHR 的工具，以提醒初级保健医生 OSA 的潜力，以改善资源匮乏诊所中 OSA 的诊断。具体目标#2：测试 通过交互式语音应答 (PDI-IVR) 系统进行同伴驱动的干预，以提高治疗依从性 存在健康差异的人群。具体目标#3：评估 旨在改善 OSA 人群诊断和治疗的多层次干预策略 健康差异。我们提议开展一项随机对照试验，招募 102 名提供者、362 名患者和 50 名经验丰富的患者 同行好友在 服务不足、睡眠障碍负担过重的人群（医疗补助和双重补助） 亚利桑那州皮马县的合格医疗保险受益人），旨在解决各地区的健康差距 OSA 的诊断和治疗。我们将使用系统级干预（基于 EHR 的工具）来针对 提供者和针对患者的患者级教育干预（PDI-IVR 系统），以便 增加向存在健康差异的人群提供基于指南的护理并促进健康公平。