Remote Patient Monitoring of Family Caregivers of Patients with Alzheimer's Disease

项目摘要 阿尔茨海默病和相关痴呆症（ADRD）患者经历了40万次可避免的住院治疗 每年，可预防的医疗保健费用高达54亿美元。除了财务成本， 住院会增加不良后果的风险，如继发感染、谵妄或急性痛苦。 为了防止住院，临床医生依靠ADRD患者的护理人员报告任何身体，行为， 以及看护者观察到的情绪变化。如果及时沟通，许多这样的变化可以 不需要住院治疗，而是通过药物干预、家庭访视或诊所访视来解决。 目前，临床医生和家庭护理人员之间的沟通取决于护理人员知道何时 电话，临床医生整理各种重要信息，以发现和解决令人担忧的变化 与即将住院相关。这一战略是不够的，因为它拖延了 ADRD患者的潜在显著变化。它还依赖于照顾者的能力， 区分无害的变化和可能导致住院的变化。尽量减少可避免的 ADRD患者的住院治疗，我们将开发和测试第一个远程患者监测平台， 数字前哨，根据情报局报告的信息。该平台将包含两个部分： 护理人员应用程序和基于网络的临床医生操作仪表板。遵循以用户为中心的设计原则， 质性研究方法，我们将询问12个照顾者的ADRD患者的内容，外观，感觉， 使用20名临床医生通过德尔菲和离散选择的输入 方法，我们将定义每日临床调查，通过这些调查，护理人员将报告身体，行为， 和情绪的变化。我们还将定义用于分析和显示的算法 临床医生行动仪表板中的所有者报告的数据。然后，我们将开发支撑平台 使用基于敏捷/看板的软件开发方法进行原型开发，并进行为期14天的试点研究， 数字前哨与中度ADRD患者的10名主要照顾者。试点的主要成果将是 可用性，通过系统可用性量表测量，并通过快速定性 方法.次要结果将是可行性，通过平台使用统计数据进行衡量。完成后， 我们将准备更新平台，以包括其他智能手机数据（例如步行步数）的集成，使用 基于机器学习的住院预测算法，并测试数字前哨在减少 在II期STTR应用中通过多中心试验进行全因住院治疗。

PROJECT SUMMARY Patients with Alzheimer’s disease & related dementia (ADRD) experience 400,000 avoidable hospitalizations annually, amounting to $5.4 billion in preventable healthcare costs. In addition to financial costs, avoidable hospitalizations increase risks for adverse outcomes, such as secondary infections, deliriums, or acute distress. To prevent hospitalizations, clinicians rely on caregivers of patients with ADRD to report any physical, behavioral, and emotional changes that caregivers observe. If communicated in a timely manner, many such changes can be addressed without hospitalization, but through pharmacological interventions, home visits, or clinic visits. Currently, communication between clinicians and family caregivers depends on the caregiver knowing when to call, and clinicians sorting through messages of various importance to find and address worrisome changes associated with an impending hospitalization. This strategy is insufficient, as it delays communication of potentially significant changes in patients with ADRD to the clinician. It also relies on caregivers’ ability to distinguish innocuous changes from those that can lead to hospitalizations. To minimize occurrence of avoidable hospitalizations in patients with ADRD, we will develop and test the first remote patient-monitoring platform, Digital Outpost, based on caregiver-reported information. The platform will contain two parts: the native Caregiver App and web-based Clinician Action Dashboard. Guided by user-centered design principles and rapid qualitative research methods, we will query 12 caregivers of patients with ADRD regarding content, look, feel, and experience of the Caregiver App. Using input of 20 clinicians through Delphi and discrete choice methodology, we will define the daily clinical surveys through which caregivers will report physical, behavioral, and emotional changes in patients with ADRD. We will also define the algorithms for analyzing and displaying caregiver-reported data in the Clinician Action Dashboard. Then, we will develop the supporting platform prototype using Agile/Kanban-based Software Development methodology and conduct a 14-day pilot study of Digital Outpost with ten primary caregivers of patients with moderate ADRD. Primary outcome of the pilot will be usability, measured by the System Usability Scale, with a follow-up assessment through rapid qualitative methods. Secondary outcome will be feasibility, measured through platform usage statistics. Upon completion, we will be poised to update the platform to include integration of other smartphone data (e.g. walking steps), use a machine-learning based predictive algorithm for hospitalization, and test efficacy of Digital Outpost in reducing all-cause hospitalization through multi-site trial in a Phase II STTR application.