Enabling Sleep Apnea Patient-Centered Care Via an Internet Intervention

这项建议的目的是研究一种新的互操作性的效果？互联网 干预？对于患有阻塞性睡眠呼吸暂停综合征（OSA）的患者， 治疗设备和基于互联网的门户网站， 管理为患者规定的金标准治疗，持续气道正压通气 压力（CPAP）。CPAP治疗依从性差是有据可查的。背后是一个 远程医疗应用的背景，在未经证实的索赔中增长迅速， 假设患者满意度、诊断准确性、临床疗效和成本效益， 他们在技术成熟度和能力方面，本提案的评估方面是 设计为随机对照临床试验？产科护理患者（对照）与i-PAP 患者（干预）。该项目的一个重要的医疗方法优势是 CPAP依从性的客观测量，其由内部微处理器测量， ?在规定压力下使用CPAP的时间。这种客观的测量方法允许 治疗依从性和疗效的反馈给患者和提供者，我们设计了 围绕这一核心特征的i-PAP干预。 因为众所周知的是，在治疗的早期就建立了依从性模式，所以i-PAP 旨在为新的CPAP用户提供他们开始使用所需的教育和支持 CPAP：学习中心提供有关OSA和CPAP的教育; 故障排除指南帮助患者排除故障并解决CPAP问题;我的图表 不仅允许图形表示治疗依从性数据，还允许图形表示治疗疗效数据 我的日志允许记录患者的日志？的经验;我的评估允许 患者可以输入自己的数据，并跟踪他们在一些措施上的进展;我的消息 委员会促进与睡眠提供者（以及未来其他OSA患者）的及时互动。 从本质上讲，i-PAP旨在提供患者想要和需要的护理， 想要和需要它。本项目的首要目标是检查这种以病人为中心， 合作护理？互联网干预？增加CPAP依从性， 有意义的水平，并检查这种影响的潜在介质。核心问题是， 包括研究的概念和经验轮廓：i-PAP干预是否具有 对病人有影响吗的护理经验，CPAP依从性和OSA结果相对于 通常的护理，如果是这样的话，可能的机制是什么？

The objective of this proposal is to examine the effect of a novel interoperable ?internet intervention? for patients with Obstructive Sleep Apnea syndrome (OSA) that integrates a telemetry treatment device and an internet-based portal that facilitates patient-centered, collaborative management for patients prescribed the gold-standard treatment, continuous positive airway pressure (CPAP). Poor treatment adherence with CPAP therapy is well-documented. Set against a backdrop of telemedicine applications that have grown as fast in unsubstantiated claims and assumptions of patient satisfaction, diagnostic accuracy, clinical efficacy, and cost-effectiveness as they have in technological sophistication and capabilities, the evaluative aspect of this proposal is designed as a randomized, controlled clinical trial?Usual Care patients (control) versus i-PAP patients (intervention). An important empirical-methodological advantage of the project is the objective measurement of CPAP adherence, which is measured by internal microprocessor as the ?amount of time CPAP is used at the prescribed pressure.? This objective measurement allows feedback of treatment adherence and efficacy to both patient and provider, and we have designed the i-PAP intervention around this central feature. Because it is well-known that adherence patterns are established very early in treatment, i-PAP is designed to provide new CPAP users with education and support they require to get started on CPAP: The Learning Center provides education about OSA and CPAP; the interactive Troubleshooting Guide helps the patients troubleshoot and solve CPAP problems; My Charts allows graphical representation not only of treatment adherence data, but treatment efficacy data as well; My Journal allows the journaling of the patient?s experiences; My Assessments allow the patients to enter their own data and track their progress on a number of measures; My Message Board facilitates timely interactions with sleep providers (and in the future other OSA patients). Essentially, i-PAP is designed to provide the care that patients want and need, at the time they want and need it. The overarching aim of the present project is to examine the effect of this patientcentered, collaborative care ?internet intervention? on increasing CPAP adherence to a clinically meaningful level and to examine the potential mediators of this effect. The central questions that encompass the conceptual and empirical contours of the study: Does the i-PAP intervention have an effect on the patient?s experience of care, CPAP adherence, and OSA outcomes relative to usual care, and if so, what are the possible mechanisms that account for the effect?