RATIONALE Obstructive sleep apnea (OSA) is a common condition that is usually treated by continuous positive airway pressure (CPAP) therapy, but poor adherence is common and is associated with worse patient outcomes and experiences. Patient satisfaction is increasingly adopted as a quality indicator by healthcare systems. OBJECTIVE We tested the hypothesis that peer-driven intervention effected through interactive voice-response(PDI-IVR) system leads to better patient satisfaction (primary outcome), care-coordination, and CPAP adherence when compared to active-control. METHODS We performed a 6-month randomized, parallel-group, controlled trial with CPAP naïve patients recruited from four centers and CPAP-adherent patients who were trained to be mentors delivering support through an IVR system. MEASUREMENTS AND RESULTS In 263 patients, intention-to-treat analysis global satisfaction for sleep-specific services was better in the intervention group (4.57+0.71 Likert scale score) than in the active-control group (4.10+1.13; P<0.001). CPAP adherence was greater in intervention group (4.5+0.2 hours/night; 62.0+3.0% of nights >4 hours usage) versus active-control group (3.7+0.2 hours/night; 51.4+3.0% of nights >4 hours usage; P=0.014 and P=0.023). When compared to active-control group, Patient Assessment of Chronic Illness Care ratings was moderately increased by an adjusted difference of 0.33+0.12 (P=0.009); Consumer Assessment of Healthcare Provider and Systems ratings was not different (adjusted difference of 0.46+0.26; P=0.076); and Client Perception of Coordination Questionnaire was mildly better in the intervention group (adjusted difference 0.15+0.07; P=0.035). CONCLUSION Patient satisfaction with care delivery, CPAP adherence, and care-coordination was improved by peer-driven intervention through an IVR system. New payor policies compensating peer-support may enable implementation of this approach. Clinical trial registration available at www. CLINICALTRIALS gov, ID: NCT02056002.

中文翻译：

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阻碍性睡眠呼吸暂停护理协调和依从性促进的同伴驱动干预：一项随机、平行组临床试验。


基本原理 阻塞性睡眠呼吸暂停 （OSA） 是一种常见病症，通常通过持续气道正压通气 （CPAP） 治疗来治疗，但依从性差很常见，并且与较差的患者预后和体验有关。患者满意度越来越多地被医疗保健系统用作质量指标。目的 我们检验了与主动控制相比，通过交互式语音应答 （PDI-IVR） 系统进行的同伴驱动干预可以提高患者满意度（主要结果）、护理协调和 CPAP 依从性。方法 我们进行了一项为期 6 个月的随机、平行组、对照试验，试验对象为从四个中心招募的 CPAP 初治患者和接受培训的 CPAP 依从患者，他们通过培训成为通过 IVR 系统提供支持的导师。测量和结果 在 263 名患者中，意向治疗分析干预组对睡眠特定服务的总体满意度（4.57+0.71 李克特量表评分）优于主动对照组（4.10+1.13;P<0.001）。干预组 （4.5+0.2 小时/晚;62.0+3.0% 的夜晚 >4 小时使用量） 高于主动对照组 （3.7+0.2 小时/夜;51.4+3.0% 的夜晚 >4 小时使用量;P=0.014 和 P=0.023）。与积极对照组相比，慢性病护理患者评估评分适度增加，调整后差异为 0.33+0.12 （P=0.009）;医疗保健提供者和系统评级的消费者评估没有差异（调整后的差异为 0.46+0.26;P=0.076）;干预组客户对协调问卷的感知略好 （调整差异 0.15+0.07;P=0.035）。 结论 通过 IVR 系统进行同伴驱动的干预，提高了患者对护理服务、CPAP 依从性和护理协调的满意度。补偿同伴支持的新付款人政策可能会使这种方法的实施成为可能。临床试验注册可在 www.CLINICALTRIALS gov，ID：NCT02056002。