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 该项目的目的是进一步开发现有的智能听诊器，以便能够 在家监测患有哮喘的小儿患者。肺部疾病对 医疗保健系统，个人和政府。他认识到哮喘是领皮 儿童和估计，全世界有2.35亿人患这种疾病，死亡超过380,000人 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 与白人美国人相比，黑人或非裔美国人。从2008年到2010年，每年的美国哮喘 患病率（黑人美国人为11.9％，而高加索人为8.1％），死亡率（0.23 ves 0.13 vess 0.13 每年的患者）和急诊室就诊（每年100名患者的6.1次访问）均为 在黑人或非裔美国人中更糟。与哮喘有关的健康差异的基本原因 知名度很高（城市空气污染，住房，饮食不良，贫穷以及社会和/或地理隔离） 但是仍然很难解决。远程管理的早期技术和移动应用具有 试图解决这些问题，结果有些积极，但需要患者自我评估和 不要包括对肺状况的客观监控。少数喘息探测器和肺部监测器 FDA已批准进行营销，但面临几个技术限制，而不是 在美国可用。 我们认为，未经训练的患者或家庭可以在家庭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气道炎症的严重程度，提供有关 恶化或改善症状的原因，提供量身定制的教育内容，并将患者直接去医疗 在局势变得急剧之前关注，从而降低到急诊室的旅行和再入院率 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）需要医疗专业知识来解释 肺部声音，（3）分析中的主观性，（4）难以使用和放置听诊器。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，最初是 旨在通过社区卫生工作者在低资源国家中使用，以区分小儿 裂纹和喘息的患者。这种智能听诊器通过包括（1）来应对上述所有挑战 自适应噪声抑制在各种噪声中被客观和主观证明是优越的 环境比传统或其他电子听诊器，（2）可以检测到的板载分析算法 儿科患者的裂纹和喘息与专家的精度相匹配，（3）均匀 取消对设备精确放置以获得准确记录的拾取表面。 在这个项目中，我们将验证该设备可以通过哮喘的孩子的父母正确使用 通过日常录音进行ED访问后的6周内监视。然后，我们计划确认我们的 现有的检测算法可以使用或修改以跟踪肺部声音严重程度的变化，其次是 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 将使用患者的反馈来迭代设备设计，以创建一个少数派和服务不足的版本 患者在家中使用舒适。