Efficacy of Clinical Decision Support and Sleep Navigation (Sleep PASS)

Children's Hospital of Philadelphia33 enrolled

Overview

The purpose of the study is to examine the feasibility, acceptability, and initial outcomes of clinical decision support (CDS) and a Sleep Navigation program to enhance primary to specialty care management of pediatric sleep-disordered breathing (SDB).

Sleep disordered breathing (SDB), which ranges from mild snoring to severe obstructive sleep apnea, impacts up to 17% of all children and is a significant public health concern. Untreated SDB is associated with significant risks to child health and well-being, including child neurobehavioral problems, hypertension, and obesity. Despite the robust evidence base for treating SDB, there are notable racial, ethnic, and socioeconomic disparities in its prevalence and treatment; even when SDB is identified in primary care visits, referral rates to specialty care are extremely low. This is a randomized controlled trial of the Sleep PASS program, with the primary objectives to (1) determine the feasibility and acceptability of CDS for SDB in primary care, and (2) determine the feasibility and acceptability of Sleep Navigation for patients with SDB who meet criteria for further clinical evaluation. The secondary objective is to examine the initial efficacy of CDS and Sleep Navigation on referral rates and rates of referral completion for SDB-related specialty care, caregiver SDB knowledge, and child sleep for patients with SDB who meet criteria for further clinical evaluation. Up to 200 caregiver-child dyads with a child (ages 2 years 0 months to \< 18 years) who has been screened for SDB symptoms in Children's Hospital of Philadelphia primary care and meets criteria for further clinical evaluation will be recruited. Up to 70 primary care clinicians will also be recruited. Eligible and interested caregiver-child dyads will be randomly assigned to the intervention condition (CDS with Sleep Navigation) or to the CDS only condition. The Sleep Navigation program will involve 1-3 meetings, conducted virtually, in-person, or via telephone, between the Sleep Navigator (SN) and the participating family. The SN will provide: SDB and sleep health psychoeducation using Patient-Family Education handouts and videos that are currently part of usual care practices; Care coordination for scheduling of specialty care referral(s) for clinical SDB evaluation; Problem-solving for family-identified barriers to accessing specialty care; and Motivational interviewing to enhance family engagement, communication, and collaboration with the family's medical team. Study procedures involves medical record review, caregiver- and child-completed questionnaires, clinician-completed questionnaires, interviews, and Navigator sessions (for the Intervention condition). Following sleep screening as part of well child visit care, electronic health records and the sleep screener will be reviewed for eligibility. Eligible and interested participants will be scheduled for a baseline assessment visit that occurs in-person or electronically and includes informed consent (or e-consent), random assignment to the intervention condition (CDS with Sleep Navigation) or to the CDS only condition, and completion of baseline measures. The intervention group will start receiving the Sleep Navigation program 1-2 weeks following baseline assessment. The CDS only condition will be directed to follow up with their primary care clinician as needed. Post-intervention and follow-up assessment will occur within 8 months of baseline questionnaire completion. Clinicians will complete questionnaires at the post-intervention phase. Randomly selected caregiver-child dyads in the intervention condition and clinicians will be invited to participate in qualitative interviews.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Enrollment

Conditions

Sleep-Disordered Breathing Obstructive Sleep Apnea Sleep

Interventions

CDS with Sleep NavigationOTHER

The Sleep Navigation program will involve 1-3 meetings between the Sleep Navigator (SN) and the participating family. Participants will also complete baseline and post-intervention assessments, and about 10 to 15 caregivers will be randomly invited to participate in an interview on the acceptability and feasibility of the program. The SN will provide: SDB and sleep health psychoeducation using Patient-Family Education handouts and videos that are currently part of usual care practices; Care coordination for scheduling of specialty care referral(s) for clinical SDB evaluation; Problem-solving for family-identified barriers to accessing specialty care; and Motivational interviewing to enhance family engagement, communication, and collaboration with the family's medical team.

CDS-onlyOTHER

Participants will complete baseline and post-intervention assessments. Participants will be able to follow-up with their primary care clinician as needed.

Eligibility

Sex: ALLMin age: 2 YearsMax age: 17 Years

Medical Language ↔ Plain English

Inclusion Criteria: Caregiver-child dyads: 1. Child is between 2 years and 17 years of age 2. Child has an abnormal SDB screen (i.e., a positive response to whether the child snores 3 or more nights/week) on the sleep screener used as part of well child visit care in the Children's Hospital of Philadelphia (CHOP) primary care network 3. Child receives well child care at Cobbs Creek or Karabots CHOP primary care network sites 4. Parental/guardian permission (informed consent) and if applicable, child assent 5. Caregiver participant is the parent or legal guardian of the child subject 6. Caregiver is 18 years of age or older 7. English-speaking Clinicians: 8. Primary care clinician practicing at Cobbs Creek or Karabots CHOP primary care network sites 9. English-speaking Exclusion Criteria: Caregiver-child dyads: 1. Caregiver is not the parent or legal guardian of child participant or is \<18 years of age 2. Non-English speaking, as intervention sessions and qualitative interviews will be conducted in English 3. Child receives well child care at a non-participating primary care site at enrollment 4. Caregivers/guardians or subjects who, in the opinion of the Investigator, may be non-compliant with study schedules or procedures Clinicians: 5. Does not see patients at Cobs Creek or Karabots CHOP primary care network sites 6. Non-English speaking, as qualitative interviews will be conducted in English

Locations (1)

Children's Hospital of Philadelphia

Philadelphia, Pennsylvania, United States

Outcomes

Primary Outcomes

CDS feasibility (proportion of patients screened for SDB at well child visits of all those eligible for screening at well child visits over the study period)

Proportion of patients screened for SDB at well child visits will be calculated with data from the electronic health records.

Time frame: up to 12 months

Clinician Decision Support Acceptability

Clinician Decision Support acceptability will be measured through clinician-completed system usability survey. This measure is rated on a 5-point Likert scale (1=strongly disagree; 2=somewhat disagree; 3=neither agree or disagree; 4=somewhat agree; and 5=strongly agree) with a range in score from 12 to 60. Higher total scores indicate better acceptability.

Time frame: up to 12 months

Acceptability of the CDS Tool

CDS acceptability will be measured by semi-structured qualitative interviews completed by the clinicians. Up to 15 primary care clinicians will be invited to participate in an interview focused on acceptability of the CDS tool. The interview includes multiple, open-ended questions completed by the clinician.

Time frame: up to 12 months

Sleep Navigator feasibility (number of Sleep Navigation activities completed among those randomized to receive Sleep Navigation)

Feasibility will be measured using data from the Sleep Navigator-completed intervention-specific fidelity checklist.

Time frame: within 8 months of baseline assessment

Sleep Navigator feasibility (Sleep Navigation activities completed among those randomized to receive Sleep Navigation)

Feasibility will be measured using data from the caregiver-completed qualitative interview.

Time frame: within 8 months of baseline assessment

Acceptability of the Sleep Navigation program (Treatment Evaluation Inventory-Short Form)

Data from ClinicalTrials.gov

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Secondary Outcomes

Sleep specialty care referral rates

The change in referral rates will be measured through the proportion of patients referred for SDB specialty care of those identified with sleep disordered breathing symptoms based on well visit sleep screener over the study period.

Time frame: through study completion, an average of 1 year

Completion of sleep specialty care referral

The change in referral completion for child sleep disordered breathing care will be measured through the proportion of patients randomized to Sleep Navigation who complete their specialty care referral of those referred to specialty care.

Time frame: through study completion, an average of 1 year

Caregiver knowledge of Sleep Disordered Breathing (SDB)

The magnitude and direction of change in caregiver knowledge of SDB will be measured through the obstructive Sleep Disordered Breathing and Adenotonsillectomy knowledge scale for caregivers. This measure is rated on a dichotomous scale (True/False) with a total raw score range of 0 to 39. Correct answers are summed to attain an overall percentage score representing the degree of knowledge level, with a minimum value of zero and a maximum of 100%. A higher percentage indicates better outcomes.