Digital health system for personalised COPD long-term management

BMC Medical Informatics and Decision Making

Research Article

Oliver Gibson¹  Carmelo Velardo¹  Syed Ahmar Shah¹  Gari Clifford¹  Lionel Tarassenko¹  Carl Heneghan²  Andrew Farmer²  Heather Rutter² 

[1] Department of Engineering Science, University of Oxford, IBME, Oxford, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;

关键词: COPD;    Self-management;    Digital health;    Adaptive thresholds;    Automatic alerts;   

DOI  :  10.1186/s12911-017-0414-8

 received in 2016-08-06, accepted in 2017-02-08,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundRecent telehealth studies have demonstrated minor impact on patients affected by long-term conditions. The use of technology does not guarantee the compliance required for sustained collection of high-quality symptom and physiological data. Remote monitoring alone is not sufficient for successful disease management. A patient-centred design approach is needed in order to allow the personalisation of interventions and encourage the completion of daily self-management tasks.MethodsA digital health system was designed to support patients suffering from chronic obstructive pulmonary disease in self-managing their condition. The system includes a mobile application running on a consumer tablet personal computer and a secure backend server accessible to the health professionals in charge of patient management. The patient daily routine included the completion of an adaptive, electronic symptom diary on the tablet, and the measurement of oxygen saturation via a wireless pulse oximeter.ResultsThe design of the system was based on a patient-centred design approach, informed by patient workshops. One hundred and ten patients in the intervention arm of a randomised controlled trial were subsequently given the tablet computer and pulse oximeter for a 12-month period. Patients were encouraged, but not mandated, to use the digital health system daily. The average used was 6.0 times a week by all those who participated in the full trial. Three months after enrolment, patients were able to complete their symptom diary and oxygen saturation measurement in less than 1 m 40s (96% of symptom diaries). Custom algorithms, based on the self-monitoring data collected during the first 50 days of use, were developed to personalise alert thresholds.ConclusionsStrategies and tools aimed at refining a digital health intervention require iterative use to enable convergence on an optimal, usable design. ‘Continuous improvement’ allowed feedback from users to have an immediate impact on the design of the system (e.g., collection of quality data), resulting in high compliance with self-monitoring over a prolonged period of time (12-month). Health professionals were prompted by prioritisation algorithms to review patient data, which led to their regular use of the remote monitoring website throughout the trial.Trial registrationTrial registration: ISRCTN40367841. Registered 17/10/2012.

【 授权许可】

CC BY   
© The Author(s). 2017