Tailored Drug Titration through Artificial Intelligence

通过人工智能定制药物滴定

• 批准号: 9341533
• 负责人: Gabriela Voskerician
• 金额: $ 84.9万
• 依托单位: OPTIMA INTEGRATED HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-06-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9341533
• 关键词: Admission activity; Adoption; Adverse effects; Affect; Age; American; Artificial Intelligence; Blood Pressure; Businesses; Caring; Clinical; Clinical Trials; Comorbidity; Computerized Medical Record; Custom; Data; Disease; Effectiveness; Emergency Situation; Emergency department visit; Ensure; Ethnic Origin; Event; Frequencies; Gender; Generations; Goals; Health; Health Insurance Portability and Accountability Act; Healthcare; Healthcare Systems; Heart failure; Hospital Costs; Hospitalization; Hypersensitivity; Hypertension; Incidence; Intelligence; Intervention Studies; Laboratories; Life Style; Logic; Measures; Medical; Medical center; Modeling; Myocardial Infarction; Office Visits; Patient Care; Patients; Pharmaceutical Preparations; Physicians; Positioning Attribute; Preventive care; Protocols documentation; Quality of Care; Quality of life; Randomized; Randomized Clinical Trials; Risk; Risk stratification; San Francisco; Schedule; Secure; Site; Stroke; Surveys; Symptoms; System; Technology; Time; Titrations; Update; Visit; arm; base; blood pressure reduction; blood pressure regulation; clinical efficacy; cloud based; commercial application; computerized data processing; cost; design; health care delivery; health care service; health data; hypertension treatment; improved; innovative technologies; medication compliance; novel; patient stratification; primary outcome; response; scale up; secondary outcome; success; tool; web services

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.

Optima Integrated Health Inc.（Optima）提案，以证明决策支持的临床效率 用于药物治疗优化的技术，它在试验临床试验中验证了Optima4bp。 Optima4bp是 设计为及时，安全优化药物治疗的物理决策/行动支持辅助 与不受控制的高血压患者（HTN）无关。 Optima4bp设计为 减少可预防的住院和中风，心力衰竭（HF）或心肌的相关事件 高于高血压（BP）导致的梗塞（MI）事件。不受控制的HTN影响3400万 美国人。与HTN相关的住院费用为1,130亿美元，占所有医院费用的15％，> 135 百万紧急DPTM。 （ed）访问。 Optima4bp将改善不受控制的HTN患者的生活质量， 并减少对美国医疗保健系统的大规模燃烧。我们的长期目标是帮助推动 从反应性支付服务的医疗保健范式转变为强调预防保健的范式 通过个性化的健康监视，评估和行动，通过及时，安全优化的药物 治疗。我们的具体目的包括：AIM（1）在随机临床中证明优化器4bp的效率 在加州大学旧金山分校医疗中心部署的试验（n = 300名患者）。患者将被随机分为 增强护理（EC）臂或Optima4bp臂（O4bp）。所有患者将使用omron10 bp臂袖带进行远程 测量他们的BP。对于EC手臂中的患者，将为医生提供每月的摘要 OMRON10数据。对于O4BP臂中的患者，除了BP每月摘要外，医生还会接受（a） 风险分层的患者阵容，（b）为每个患者进行药物优化的下一步操作，（c）访问 到Optima4BP的安全网络服务治疗模型，以调查当前患者的变化 数据可能会影响药物选择（例如，如果降低了BP目标，则可以改变药物的选择）。然后我们会 检查臂之间的BP值降低（成功：> 7 mmHg降低收缩期；> 4 mmHg降低 O4BP与EC的舒张期以及O4BP和EC之间的次要结果：药物治疗 动作频率； ED由于HTN相关符号和中风的相关住院治疗而引起的ED入院 或mi;和HTN管理的整体成本。目的（2）Optimizema4BP数据处理步骤将被优化为 将其功能扩展到> 1000/天的患者案例处理能力。 3个特定的优化处理工具 将开发：Optima提取，转换和负载（OETL）； Optima调查生成器（OSG）和Optima 消息构建器（OMB）。 OETL将提供简化的调度逻辑，以从EPIC®EMR提取数据 （电子病历），优化Optima4bp中的数据映射脚本，并优化数据上传 协议。 OSG将优化患者调查，患者反应和 分配患者对特定处理模块的反应。 OMB将确保简化的计划 风险分层更新和计划在EPIC®EHR内的物理内式内部消息系统的交付。