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。肺部疾病给人们带来了严重的负担， 医疗系统、个人和政府。世卫组织认为哮喘是世界上最主要的慢性疾病， 据估计，全世界有2.35亿人患有这种疾病，超过38万人死于 2015年的疾病。在美国，哮喘患病率和疾病负担不成比例地影响着 黑人或非裔美国人与白色美国人相比。从2008年到2010年，每年美国哮喘 患病率（美国黑人为11.9%，白人为8.1%）、死亡率（0.23/1000，白人为0.13/1000 患者/年）和急诊科就诊（18.4 vs 6.1次/100例患者/年）， 黑人和非裔美国人的情况更糟。与哮喘相关的健康差异的根本原因 （城市空气污染、住房、不良饮食、贫困以及社会和/或地理隔离） 但仍然很难解决。用于远程管理的早期技术和移动的应用程序 试图解决这些问题，有些积极的结果，但需要病人自我评估， 不包括肺状态的客观监测。少量喘息检测器和肺部监测器 已经被FDA批准上市，但面临着一些技术限制， 在美国可商购。 我们的理由是，一个长期的监测解决方案，可以在家里使用的未经培训的病人，或家庭 患者的成员，可以检测和监测患者气道炎症的严重程度， 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跟进，从而减少急诊室的行程和再入院率 到医院我们发现，在考虑长期听诊监测解决方案时存在一些挑战 在非传统的临床环境中：（1）不可预测的环境噪声，（2）需要医学专业知识来解释 肺音，（3）分析中的主观性，以及（4）使用和放置听诊器的困难。为了 克服了许多这些挑战，研究小组开发了一种智能听诊器， 预期在资源匮乏的国家由社区卫生工作者使用，以区分儿科 有爆裂音和喘息的病人。这款智能听诊器解决了上述所有挑战，包括（1） 已被客观和主观地证明在所有类型的噪声中具有上级优势的自适应噪声抑制 环境比传统或其他电子听诊器，（2）板上分析算法，可以检测 在儿科患者中的爆裂声和喘息声，其准确性与专家相匹配，以及（3）制服 拾取表面，消除了对设备的精确放置的要求，以获得准确的记录。 在本项目中，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： 通过每日记录，在艾德访视后的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度的变化， 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 我将利用患者的反馈来改进设备设计，以创建一个少数人和服务不足的版本 患者可以在家中舒适地使用。