Killian Jackson A, Jain Manish, Jia Yugang, Amar Jonathan, Huang Erich, Tambe Milind
Harvard University, Cambridge, MA, United States.
Verily Life Sciences, South San Francisco, CA, United States.
JMIR Diabetes. 2024 Mar 15;9:e52688. doi: 10.2196/52688.
BACKGROUND: Digital health programs provide individualized support to patients with chronic diseases and their effectiveness is measured by the extent to which patients achieve target individual clinical outcomes and the program's ability to sustain patient engagement. However, patient dropout and inequitable intervention delivery strategies, which may unintentionally penalize certain patient subgroups, represent challenges to maximizing effectiveness. Therefore, methodologies that optimize the balance between success factors (achievement of target clinical outcomes and sustained engagement) equitably would be desirable, particularly when there are resource constraints. OBJECTIVE: Our objectives were to propose a model for digital health program resource management that accounts jointly for the interaction between individual clinical outcomes and patient engagement, ensures equitable allocation as well as allows for capacity planning, and conducts extensive simulations using publicly available data on type 2 diabetes, a chronic disease. METHODS: We propose a restless multiarmed bandit (RMAB) model to plan interventions that jointly optimize long-term engagement and individual clinical outcomes (in this case measured as the achievement of target healthy glucose levels). To mitigate the tendency of RMAB to achieve good aggregate performance by exacerbating disparities between groups, we propose new equitable objectives for RMAB and apply bilevel optimization algorithms to solve them. We formulated a model for the joint evolution of patient engagement and individual clinical outcome trajectory to capture the key dynamics of interest in digital chronic disease management programs. RESULTS: In simulation exercises, our optimized intervention policies lead to up to 10% more patients reaching healthy glucose levels after 12 months, with a 10% reduction in dropout compared to standard-of-care baselines. Further, our new equitable policies reduce the mean absolute difference of engagement and health outcomes across 6 demographic groups by up to 85% compared to the state-of-the-art. CONCLUSIONS: Planning digital health interventions with individual clinical outcome objectives and long-term engagement dynamics as considerations can be both feasible and effective. We propose using an RMAB sequential decision-making framework, which may offer additional capabilities in capacity planning as well. The integration of an equitable RMAB algorithm further enhances the potential for reaching equitable solutions. This approach provides program designers with the flexibility to switch between different priorities and balance trade-offs across various objectives according to their preferences.
背景:数字健康项目为慢性病患者提供个性化支持,其有效性通过患者实现个体临床目标结果的程度以及项目维持患者参与度的能力来衡量。然而,患者退出以及不公平的干预实施策略(这可能无意中对某些患者亚组造成不利影响)对实现最大有效性构成挑战。因此,尤其在资源有限的情况下,能够公平地优化成功因素(实现目标临床结果和持续参与)之间平衡的方法将是理想的。 目的:我们的目标是提出一种数字健康项目资源管理模型,该模型综合考虑个体临床结果与患者参与度之间的相互作用,确保公平分配并允许进行能力规划,并使用关于慢性病2型糖尿病的公开可用数据进行广泛模拟。 方法:我们提出一种 restless 多臂老虎机(RMAB)模型来规划干预措施,以共同优化长期参与度和个体临床结果(在这种情况下以达到目标健康血糖水平来衡量)。为了减轻 RMAB 通过加剧组间差异来实现良好总体表现的倾向,我们为 RMAB 提出了新的公平目标,并应用双层优化算法来解决这些目标。我们制定了一个患者参与度和个体临床结果轨迹联合演变的模型,以捕捉数字慢性病管理项目中感兴趣的关键动态。 结果:在模拟练习中,我们优化后的干预策略使12个月后达到健康血糖水平的患者增加了多达10%,与标准治疗基线相比,退出率降低了10%。此外,与现有最佳方法相比,我们新的公平策略将6个人口统计学组在参与度和健康结果方面的平均绝对差异降低了多达85%。 结论:将个体临床结果目标和长期参与动态纳入考虑来规划数字健康干预措施既可行又有效。我们建议使用 RMAB 顺序决策框架,该框架在能力规划方面可能也具有额外的能力。公平 RMAB 算法的整合进一步增强了达成公平解决方案的潜力。这种方法为项目设计者提供了灵活性,使其能够根据自身偏好,在不同优先级之间切换,并平衡各种目标之间的权衡。
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