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Peer-driven intervention as an alternative model of care delivery and coordination for sleep apnea
Investigator (PI): Parthasarathy, Sairam
Performing Organization (PO): (Current): University of Arizona, College of Medicine, Department of Medicine, Division of Pulmonary, Allergy, Critical Care, & Sleep Medicine / (520) 626-6114
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2014
Final Year: 2019
Record Source/Award ID: PCORI/IHS-1306-02505
Funding: Total Award Amount: $2,117,118
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Fragmentation of care can lead to poor treatment adherence in patients with chronic medical conditions which can, in turn, 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 health care coordination, or difficulty accessing various health care providers across a front desk which serves as a health care bottleneck. Better efficiency in health care 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 health care system. Specifically, such community health education volunteers (peer-buddies) who are experienced in managing their disease condition 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. An additional important advantage is the peer-buddy's ability to relate to the patient in a manner consistent with their social, ethnic, and cultural beliefs without language barriers or differences that may stem from socioeconomic strata. We will use sleep apnea as an example condition to test the effect of a peer-buddy helper (combined with the universal availability of personal cell phones) on the problem of poor care coordination and treatment adherence to the CPAP treatment for sleep apnea. Sleep apnea is a very common condition that affects 7-12% of the US population and if left untreated can lead to poor health and even death through its effects on high blood pressure, heart disease, stroke, and motor vehicle accidents. Fortunately, CPAP therapy can lead to a three-fold reduction in such consequences, but patient adherence to such CPAP treatment is generally poor. We have recently completed a small study that demonstrated improved usage of CPAP treatment by patients receiving help from a peer-buddy with excellent results. We propose to further enhance the peer-buddy community-volunteer concept in our proposed research by combining this with cell phone technology and a telephone exchange that improves access to health care providers, technicians, and home care companies. We hope to show that active community participation by experienced lay individuals assisted by the universal availability of cheap cell phones can improve the reach and effectiveness of our health care system in improving the health and wellbeing of our patients. If successful, such an innovative and community-based approach can be applied to other chronic medical conditions. More on this project: (1) Mosier JM, Hypes C, Joshi R, Whitmore S, Parthasarathy S, Cairns CB. Ventilator Strategies and Rescue Therapies for Management of Acute Respiratory Failure in the Emergency Department. Ann Emerg Med. 2015 Nov;66(5):529-41. doi: 10.1016/j.annemergmed.2015.04.030. Epub 2015 May 23. Review. PubMed PMID: 26014437. (2) Combs D, Goodwin JL, Quan SF, Morgan WJ, Parthasarathy S. Modified STOP-Bang Tool for Stratifying Obstructive Sleep Apnea Risk in Adolescent Children. PLoS One. 2015 Nov 18;10(11):e0142242. doi: 10.1371/journal.pone.0142242. eCollection 2015. PubMed PMID: 26581088; PubMed Central PMCID: PMC4651349. (3) Parthasarathy S, Shetty S, Combs D. Mend the Mind and Mind the "MCC". Sleep. 2015 Jul 1;38(7):1001-3. doi: 10.5665/sleep.4794. PubMed PMID: 26085292; PubMed Central PMCID: PMC4481002. (4) Combs D, Goodwin JL, Quan SF, Morgan WJ, Parthasarathy S. Longitudinal differences in sleep duration in Hispanic and Caucasian children. Sleep Med.2016 Feb;18:61-6. doi: 10.1016/j.sleep.2015.06.008. PubMed PMID: 26299467; PubMed Central PMCID: PMC4548806. (5) Shetty S, Parthasarathy S. Obesity Hypoventilation Syndrome. Curr Pulmonol Rep. 2015 Mar 1;4(1):42-55. PubMed PMID: 26029497; PubMed Central PMCID: PMC4444067. (6) Flygare J, Parthasarathy S. Narcolepsy: let the patient's voice awaken us! Am J Med. 2015 Jan;128(1):10-3. doi: 10.1016/j.amjmed.2014.05.037. PubMed PMID: 24931392; PubMed Central PMCID: PMC4264987. (7) C. Poongkunran, S.G. John, A.S. Kannan, S. Shetty, C. Bime, S. Parthasarathy. Clinical Research Study: A Meta-analysis of Sleep-promoting Interventions During Critical Illness. The American Journal of Medicine. 2015 Oct;128(10):1126-1137.e1. doi: 10.1016/j.amjmed.2015.05.026. (8) Combs D, Shetty S, Parthasarathy S. Advances in Positive Airway Pressure Treatment Modalities for Hypoventilation Syndromes. Sleep Med Clin. 2014 Sep;9(3):315-325. PubMed PMID: 25346650; PubMed Central PMCID: PMC4205540. (9) For Healthier Nights and Longer Lives--A narrative on this project, with a look at how experienced patients help those newly diagnosed with sleep apnea learn to use a challenging but effective treatment.
MeSH Terms:
  • Cell Phone
  • * Continuity of Patient Care
  • Continuous Positive Airway Pressure
  • Cultural Characteristics
  • Humans
  • Language
  • Patient Compliance
  • * Peer Group
  • Sleep Apnea Syndromes /*therapy
  • Social Class
  • * Social Support
  • United States
  • Volunteers
Country: United States
State: Arizona
Zip Code: 85724
UI: 20143568
CTgovId: NCT02056002
Project Status: Completed
Record History: ('2017: Project extended to 2018.',) ('Project end year extended to 2019; corrected project Title (changed alternate to alternative), 7/26/2021',)