DiSCERN: Advanced PD Therapy Candidacy and Evaluation System

总结 目的是设计、开发和临床评估DiSCERN，一种标准化的远程医疗工具， 确定帕金森病（PD）患者将受益于先进的治疗（AT）， 确定AT接受者何时需要治疗调整。一旦长期使用PD药物导致 运动波动和运动障碍以及所有的非侵入性治疗已经用尽，AT（例如，深部脑 刺激，药物泵）经常被推荐。虽然学术医疗中心的专家可能会适当地 在确定评估技术候选人时，由于有限的评估机会和不公平的使用，评估技术没有得到充分利用。 为PD人群的一个相当大的子集提供资源。通过DiSCERN进行远程筛查和监测， 改善患者选择，减少差距，扩大农村人口和弱势群体的可及性 社区.该系统将使患者、提供者和医疗保健机构参与进来，并赋予他们权力， 改善健康状况，提供医疗保健，减少健康差距。这种移动的医疗技术将 包括患者友好型智能手机应用程序、非运动评估和无线可穿戴传感器， 持续监测PD运动症状、并发症和生活质量（QoL）。我们先前已经 用于远程监测PD运动症状和副作用的商业化可穿戴设备和移动的应用程序， 这将大大降低项目的风险。尽管如此，仍需要新的开发和验证工作， 将这项新技术商业化。创新包括：1）PD监测算法与 情境感知活动检测，用于改善PD运动评估和QoL量化; 2）实施 智能手机和可穿戴设备上的算法; 3）开发使用电机的预测模型 和非运动功能，以准确识别PD患者，这些患者是AT的良好候选人;以及4） 当AT接受者需要治疗调整时提醒临床医生的模型的实施。通过 与AT系统集成后，DiSCERN将改善临床医生的体验，并允许有限的可用性， 专家将护理扩展到多样化和不断增长的PD人群，否则他们可能无法获得AT。 阶段I包括：1）在PD患者数据上验证上下文感知活动检测算法; 2）确定 特定活动或活动水平与PD QoL相关的程度; 3）使用临床医生反馈来识别 收集的数据特征，可用于告知AT临床决策;以及4）识别将 用于最终系统。第二阶段包括：1）情境感知活动检测和PD症状的过渡 将量化算法应用到智能手机和可穿戴芯片上; 2）开发智能手机应用程序， 将数据收集、非运动评估和数据传输集成到云端;以及3）从 AT候选人在AT启动之前和之后的几个月内开发出准确识别AT的模型 候选人以及何时需要调整。DiSCERN将提高治疗效率，扩大可及性， 并导致更多的患者选择AT。

Summary The objective is to design, develop, and clinically assess DiSCERN, a standardized telemedicine tool for identifying patients with Parkinson’s disease (PD) who would benefit from advanced therapies (AT) and determining when AT recipients need therapy adjustments. Once chronic PD medication usage results in motor fluctuations and dyskinesias and all non-invasive therapies have been exhausted, AT (e.g., deep brain stimulation, drug pumps) is often recommended. While experts at academic medical centers may appropriately identify AT candidates, AT is underutilized due to limited access and inequitable utilization of limited evaluative resources for a sizable subset of the PD population. Remote screening and monitoring with DiSCERN will improve patient selection, reduce disparities, and expand access for rural populations and disadvantaged communities. The system will engage and empower patients, providers, and healthcare institutions and lead to improved health, healthcare delivery, and the reduction of health disparities. This mobile health technology will include a patient friendly smartphone app, non-motor assessments, and wireless wearable sensors for continuously monitoring PD motor symptoms, complications, and quality of life (QoL). We have previously commercialized wearables and mobile apps for remote monitoring of PD motor symptoms and side effects, which will significantly de-risk the project. Still, novel development and validation efforts are required to commercialize this new technology. Innovations include: 1) integration of PD monitoring algorithms with context aware activity detection for improved PD motor assessment and QoL quantification; 2) implementation of the algorithms on a smartphone and wearable device; 3) development of a predictive model that uses motor and non-motor features to accurately identify PD patients who would be good candidates for AT; and 4) implementation of a model that alerts clinicians when an AT recipient needs a therapy adjustment. Through integration with AT systems, DiSCERN will improve the clinician experience and allow the limited availability of specialists to scale care to a diverse and growing PD population, who may not otherwise have access to AT. Phase I includes: 1) validation of context aware activity detection algorithms on PD patient data; 2) determining the extent specific activities or activity levels correlate with PD QoL; 3) using clinician feedback to identify collected data features that are useful in informing AT clinical decisions; and 4) identification of wearables to be used in the final system. Phase II includes: 1) transition of context aware activity detection and PD symptom quantification algorithms onto a smartphone and wearable chips; 2) development of a smartphone app that integrates data collection, non-motor assessment, and data-transfer to the cloud; and 3) collecting data from AT candidates in the months before and after AT is initiated to develop models that accurately identify AT candidates and when AT adjustments are needed. DiSCERN will improve therapy efficiency, expand access, and result in more patients opting for AT.