Tailored Drug Titration through Artificial Intelligence

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Optima Integrated Health Inc. (Optima) proposes to demonstrate the clinical efficacy of the decision support technology for medication treatment optimization it validated in a pilot clinical trial, optima4BP. optima4BP is designed as a physician decision/action support aid in timely and safely optimizing medication treatment independent of in-office visits, for patients with uncontrolled hypertension (HTN). optima4BP is designed to reduce preventable hospitalizations and the associated incidence of stroke, heart failure (HF) or myocardial infarction (MI) events resulting from high blood pressure (BP) above goal. Uncontrolled HTN affects 34 million Americans. The cost of HTN-associated hospitalizations is $113 billion, or 15% of all hospital costs, with >135 million Emergency Dptm. (ED) visits. optima4BP will improve the quality of life for uncontrolled HTN patients, and reduce this massive burden on the US healthcare system. Our long term objective is to help drive the transformation from the reactive pay-for-service healthcare paradigm to one that emphasizes preventative care through personalized health surveillance, assessment, and action via timely and safely optimized medication treatment. Our specific aims include: Aim (1) demonstrating the efficacy of optima4BP in a randomized clinical trial (n=300 patients) deployed at UC San Francisco Medical Center. Patients will be randomized to an enhanced care (EC) arm or an optima4BP arm (O4BP). All patients will use Omron10 BP arm cuff to remotely measure their BP. For the patients in the EC arm, physicians will be provided with a monthly summary of the Omron10 data. For patients in the O4BP arm, aside from the BP monthly summary, physicians will receive (a) a risk stratified patient roster, (b) next step actions in medication optimization for each patient, and (c) access to optima4BP's secure web-service medication treatment modeling to investigate how changing current patient data could affect medication choice (e.g., change in medication choice if BP goal is lowered). We will then examine the BP value reduction between arms (success:>7 mmHg decreased systolic; >4 mmHg decreased diastolic of O4BP vs. EC), along with secondary outcomes between O4BP and EC: medication treatment action frequency; ED admissions due to HTN-related symptoms and associated hospitalizations for stroke, HF or MI; and overall cost of HTN management. Aim (2) optima4BP data processing steps will be optimized to scale-up its capability to >1000/day patient cases processing power. 3 specific optimization processing tools will be developed: Optima Extract, Transform, and Load (OETL); Optima Survey Generator (OSG), and Optima Message Builder (OMB). OETL will provide streamlined scheduling logic to extracting data from Epic® EMR (electronic medical record), optimize data mapping scripts within optima4BP, and optimize data uploading protocols. OSG will optimize the current generation protocol for patient surveys, patient response, and assignment of patient responses to specific processing modules. OMB will ensure streamlined scheduling of risk stratification updates and scheduled delivery to physician In-Basket messaging system within Epic® EHR.