Feelix@Home: A smart stethoscope to improve pediatric asthma management for urban minority families

Feelix@Home：智能听诊器改善城市少数民族家庭小儿哮喘管理

• 批准号: 9796618
• 负责人: Ilene Joy Busch-Vishniac
• 金额: $ 22.22万
• 依托单位: SONAVI LABS, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9796618
• 关键词: Accident and Emergency department; Acoustics; Acute; Address; Admission activity; Affect; African American; Air Pollution; Algorithmic Analysis; Algorithms; Architecture; Asthma; Auditory; Auscultation; Back; Baltimore; Businesses; Caregivers; Caring; Caucasians; Censuses; Cessation of life; Child; Childhood Asthma; Chronic Disease; Cities; Clinic; Clinical; Community Health Aides; Complex; Country; Crackles; Data; Data Set; Detection; Development; Device Designs; Devices; Diet; Disease; Electronic Health Record; Emergency Situation; Emergency department visit; Environment; Face; Family; Family member; Feedback; Foundations; Geography; Goals; Government; Health; Healthcare; Healthcare Systems; Home environment; Hospitalization; Hospitals; Housing; Human Resources; Individual; Intelligence; Intervention; Letters; Link; Lung; Lung diseases; Marketing; Medical; Minority; Monitor; Noise; Outcome; Output; Parents; Participant; Patient Monitoring; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Pediatrics; Performance; Phase; Physicians; Population; Poverty; Prevalence; Process; Pulmonology; Reporting; Research; Research Personnel; Resources; Respiratory Sounds; Self Assessment; Severities; Signal Transduction; Software Engineering; Solid; Specialist; Stethoscopes; Surface; System; Technology; Testing; Time; Training; Underserved Population; United States; Universities; Urban Population; Visit; Wheezing; Work; aged; airway inflammation; asthmatic patient; burden of illness; caucasian American; clinically relevant; computer aided detection; cost; detector; digital; health disparity; improved; individual patient; insight; mobile application; monitoring device; mortality; patient population; pediatric patients; readmission rates; recruit; rural underserved; signal processing; social; symptomatic improvement; trend; urban underserved; usability

Project Summary The goal of this project is to further develop an existing smart stethoscope in order to be capable of monitoring pediatric patients at home who suffer from asthma. Lung diseases impose a serious burden on healthcare systems, individuals and governments. WHO recognizes asthma as the leading chronic disease in children and estimates that 235 million people suffer from the disease worldwide, with over 380,000 deaths from the disease in 2015. In the United States, asthma prevalence and disease burden disproportionately affect Blacks or African-Americans compared with White Americans. From 2008 to 2010, the annual US asthma prevalence (11.9% for Black Americans versus 8.1% in Caucasians), mortality rate (0.23 versus 0.13 per 1000 patients per year), and emergency department visits (18.4 versus 6.1 visits per 100 patients per year) were all worse among Blacks or African-Americans. The fundamental causes of health disparities in relation to asthma are well understood (urban air pollution, housing, poor diet, poverty, and social and/or geographical isolation) but remain very difficult to solve. Early technological and mobile applications for remote management have attempted to address these problems, with somewhat positive results, but require patient self-assessment and do not include objective monitoring of lung status. A small number of wheeze detectors and pulmonary monitors have been approved for marketing by the FDA, but face several technological limitations and are not commercially available in the US. We reasoned that a long-term monitoring solution that can be used in the home by untrained patients, or family members of patients, could detect and monitor severity of airway inflammation in patients, provide insight into reasons for worsening or improved symptoms, provide tailored educational content and direct patients to medical follow before the situation becomes acute, thus reducing trips to emergency departments and readmission rates to hospitals. We find that several challenges exist when considering long term auscultatory monitoring solutions in non-traditional clinical settings: (1) unpredictable ambient noise, (2) the need for medical expertise to interpret lung sounds, (3) subjectivity in the analysis, and (4) difficulty using and placing the stethoscope. In order to overcome many of these challenges, the research team developed a smart stethoscope that was originally intended for use in low-resource countries by community health workers to differentiate between pediatric patients with crackles and wheezes. This smart stethoscope address all the challenges above by including (1) adaptive noise suppression that has been objectively and subjectively proven to be superior in all types of noise environments than traditional or other electronic stethoscopes, (2) on-board analysis algorithms that can detect crackles and wheezes in pediatric patients with an accuracy that matches that of a specialist, and (3) a uniform pickup surface that removes the requirement for exact placement of the device to get an accurate recording. In this project, we will validate that the device can be correctly used by parents of children with asthma through monitoring over a 6-week period following an ED visit through daily recordings. We then plan to confirm that our existing detection algorithms can be used or modified to track changes in the lung sound severity, followed by correlating these algorithm outputs with patient reported outcomes and environmental data. Simultaneously, we will be using patient feedback to iterate on the device design to create a version that minority and underserved patients are comfortable using in their home.

项目摘要 该项目的目标是进一步开发现有的智能听诊器，以便能够 在家中监测患有哮喘的儿科患者。肺部疾病给我们带来了严重的负担 医疗保健系统、个人和政府。世卫组织承认哮喘是#年的主要慢性病 估计全世界有2.35亿人患有这种疾病，其中超过38万人死于 这种疾病发生在2015年。在美国，哮喘患病率和疾病负担对 黑人或非裔美国人与美国白人相比。从2008年到2010年，美国每年的哮喘 患病率(美国黑人11.9%，白人8.1%)，死亡率(0.23‰，0.13‰) 急诊科就诊次数(每年每百名患者就诊次数分别为18.4次和6.1次) 黑人或非裔美国人的情况更糟。与哮喘有关的健康差距的根本原因 (城市空气污染、住房、糟糕的饮食、贫困以及社会和/或地理上的孤立) 但仍然很难解决。用于远程管理的早期技术和移动应用程序 试图解决这些问题，取得了一些积极的结果，但需要患者自我评估和 不包括对肺部状况的客观监测。少量的喘息探测器和肺部监护仪 已经被FDA批准上市，但面临着几个技术限制，没有 在美国可以商业化销售。 我们认为，一种可供未经训练的患者或家属在家中使用的长期监测解决方案 患者的成员，可以检测和监测患者的呼吸道炎症严重程度，提供洞察 症状恶化或改善的原因，提供量身定制的教育内容，并指导患者就医 在情况变得严重之前采取后续行动，从而减少前往急诊室的次数和再住院率 去医院。我们发现，在考虑长期听诊监测解决方案时，存在几个挑战 在非传统临床环境中：(1)不可预测的环境噪声，(2)需要医疗专家来解释 肺音，(3)分析的主观性，(4)听诊器的使用和放置困难。为了 克服了其中的许多挑战，研究团队开发出了一种智能听诊器，最初是 旨在由社区卫生工作者在低资源国家使用，以区分儿科 有爆裂声和喘息声的病人。这款智能听诊器通过包括(1) 自适应噪声抑制已被客观和主观地证明在所有类型的噪声中都是优越的 比传统或其他电子听诊器更好的环境，(2)可以检测到 儿科患者发出的爆裂声和喘息声的准确度与专科医生相当，(3)制服 拾取器表面，消除了精确放置设备以获得准确记录的要求。 在这个项目中，我们将通过以下方式验证哮喘儿童的父母可以正确使用该设备 通过每日录音，在急诊科就诊后的6周内进行监测。然后我们计划确认我们的 可以使用或修改现有的检测算法来跟踪肺音严重性的变化，然后是 将这些算法输出与患者报告的结果和环境数据相关联。同时，我们 将使用患者反馈来迭代设备设计，以创建一个少数人和未得到充分服务的版本 患者在家中使用时很舒服。