Velardo Carmelo, Shah Syed Ahmar, Gibson Oliver, Clifford Gari, Heneghan Carl, Rutter Heather, Farmer Andrew, Tarassenko Lionel
Department of Engineering Science, University of Oxford, IBME, Oxford, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
BMC Med Inform Decis Mak. 2017 Feb 20;17(1):19. doi: 10.1186/s12911-017-0414-8.
Recent 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.
A 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.
The 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.
Strategies 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 registration: ISRCTN40367841 . Registered 17/10/2012.
近期的远程医疗研究表明，对患有长期疾病的患者影响较小。技术的使用并不能保证持续收集高质量症状和生理数据所需的依从性。仅靠远程监测不足以成功管理疾病。需要一种以患者为中心的设计方法，以便实现干预措施的个性化，并鼓励患者完成日常自我管理任务。
设计了一个数字健康系统，以支持慢性阻塞性肺疾病患者自我管理病情。该系统包括在消费级平板电脑个人计算机上运行的移动应用程序，以及负责患者管理的医护人员可访问的安全后端服务器。患者的日常活动包括在平板电脑上完成一份自适应电子症状日记，并通过无线脉搏血氧仪测量血氧饱和度。
该系统的设计基于以患者为中心的设计方法，并参考了患者研讨会的意见。随后，随机对照试验干预组的110名患者获得了平板电脑和脉搏血氧仪，为期12个月。鼓励患者（但不强制）每天使用数字健康系统。所有参与完整试验的患者平均每周使用6.0次。入组三个月后，患者能够在不到1分40秒的时间内完成症状日记和血氧饱和度测量（96%的症状日记）。基于使用前50天收集的自我监测数据，开发了定制算法，以个性化警报阈值。
旨在完善数字健康干预的策略和工具需要反复使用，以实现向最优、可用设计的收敛。“持续改进”使用户反馈能够立即影响系统设计（如收集质量数据），从而在较长时间（12个月）内实现对自我监测的高度依从性。优先级算法促使医护人员查看患者数据，这导致他们在整个试验过程中定期使用远程监测网站。
试验注册号：ISRCTN40367841。2012年10月17日注册。
