Personalized Mobile-Social Medicine for Chronic Disease: Pilot Clinical Trial Results Towards a Theory of Sustained Health Behavior Change
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The findings from the implementation of a novel mobile health gaming application developed at the University of Maryland in partnership with Fraunhofer USA and tested at the Baltimore Veteran’s Administration Hospital will be discussed. The Personalized Mobile Medicine System (“PM2Sys”) is a cloud-based software system built on Google App Engine Components that integrates cutting-edge research from the psychology, health behavior, information systems and medicine domains in the form of a mobile device-based application targeted towards older adults suffering from chronic disease. DiaSocial is the first application built on PM2Sys and it is targeted towards type 2 diabetes. The technology is also designed to test research hypotheses on the role of social engagement types and tailoring of interventions using personality and other data. A pilot randomized control trial of DiaSocial was completed in May 2015. This 90-day trial included 29 older adults across four groups with varied intervention design and supporting processes. Participants were given a cellular-connected digital tablet, the application and an integrated wearable activity tracker. Clinical providers used the system to continuously monitor and communicate with some patients. In half the groups, patient teams competed for the best scores. The presentation will provide insights from the quantitative and qualitative analysis, which includes over 15,000 data points and interviews with 23 patients and the provider team. Design and usability lessons, and how applications may be more specifically tailored based on clinical, behavioral, app usage, and psychological dimensions of users will be featured.
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Personalized Mobile-Social Medicine for Chronic Disease: Pilot Clinical Trial Results Towards a Theory of Sustained Health Behavior Change
- 1. Personalized Mobile Medicine for Chronic Disease: Towards a Theory of Sustained Health Behavior Change 5th Games for Health Europe November 2, 2015 Kenyon Crowley, MBA, MS, CPHIMS Deputy Director of CHIDS, Robert H. Smith School of Business, University of Maryland Managing Partner, DiaSocial PhD Information Science Scholar, University of Maryland iSchool @healthIT
- 2. Team 2 European Collaborators (partial list): © CHIDS
- 3. Presentation Flow Background System Pilot Trial Structure and Results Takeaways Future 3 © CHIDS
- 5. Problem 5 © CHIDS Data and Image: American Diabetes Association
- 6. Problem 6 © CHIDS Data and Image: CDC, NIDDK, LA Times
- 7. Problem 7 © CHIDS Data and Image: IDF Diabetes Atlas
- 8. 8 © CHIDS “For diabetes in particular, we know there's a relationship between lack of glucose regulation and complications like blindness and kidney failure. So if you were diabetic and you knew that you could get your glucose in a tight, normal range just by adjusting your lifestyle, wouldn't that be great.” - Eric Topol, MD Opportunity
- 9. System Personalized Mobile Medicine System (“PM2Sys”) is a cloud- based software system that integrates research from the psychology, health behavior, information systems and medicine domains precision behavioral intervention Success algorithms and mobile application DiaSocial, 1st app on the platform, targets T2 diabetes with a focus on older adults Testing hypotheses on role of social engagement types, tailoring of intervention using personality and other data Initial pilot randomized clinical trial completed May 2015 Prior: Several focus groups and co-design sessions in United States and Germany 9 © CHIDS
- 10. 10 © CHIDS© CHIDS
- 11. Pilot Trial A1C as primary metric with additional measures for clinical, behavioral, usage and psychological measures 11 Control (5) A (5) B (5) C (6) D (6) 95 Usual care February 2015 May 2015 Among the 27 patients 3 females, 24 males Age 67.5, [61, 86] Initial A1C: 9.0, [7.6, 11.6] © CHIDS
- 12. Psychological measures 5 areas in pre-experiment questionnaire Regulatory Mode (Assessment, Locomotion), Need for Closure , Epistemic Authority (Self-ascribed and Physician), Individualism and Collectivism 6 areas in pre and post experiment questionnaire Mindset, Self-Efficacy, Regulatory Focus (Prevention, Promotion), Commitment, Goal Progress, Setbacks © CHIDS12
- 13. Usage 13 © CHIDS > 70% used 60 days of trial > 43% used 80 days of trial
- 14. Group Performance 14 © CHIDS
- 15. Usage across teams Average total scores: 5,057 > Comparing B and D: team does increase usage > Comparing C and D: Provider does increase usage > Might have complimentary effects b/w team and provider. > Caution: Baseline A has higher psych measures than other teams. > Interviews show that patients do not make much use of team and provider features. © CHIDS15
- 16. Effects 16 © CHIDS Treatment group: -0.56% Control group: -0.34%
- 17. Effects 17 © CHIDS Coefficient: -0.00028 P-Value: 0.0491 A1C v. Total Score Coefficient: -0.0179 P-Value: 0.0381 A1C v. Days of App Use Correlation
- 18. Results Across 22 intervention patients… 73% saw an improvement in A1c 4.9% average reduction in A1c less outliers. Full treatment group had 0.98 average drop in A1C. The top ½ of patients showed 14.0% decrease in A1C Assessment and Prevention measures suggestive of success Many patients voiced improved understanding and perceived self- efficacy in diabetes management Many indicated like the app, mixed perceptions re gaming aspects Features identified for V2.0 – better communication, analytics, usability, game design, education 18 © CHIDS
- 19. Tailoring and Personalization Clinical State Personality Usage Behaviors 19 > Prescribing > Message > Content > Framing > Tone > Teaming > Timing © CHIDS
- 20. Takeaways 20 > Suggest mobile health precision behavioral interventions for diabetes can be effective for some patients > Interaction between personality and app prescribing + use offers applied research targets for digital health solutions > App > Add automatic messages > Simplify usage > Experiment Process > Measure A1C right before/after experiment > Cluster patients before grouping (i.e. personality randomization) > Add offline activities for team > Monitor usage during the experiment © CHIDS
- 21. Next Steps Version 2.0 trial being planned for early 2016 Communication upgrades, video-chat, provider dashboard updates Tailoring algorithms development Decision support Message library, games, visualization development Moving to smartphone as primary platform Commercialization explorations Future Additional data types Machine learning and self-adaptive More device integration 21 © CHIDS
- 22. Dank u wel! Kenyon Crowley kcrowley@rhsmith.umd.edu @HealthIT 22 © CHIDS
- 23. Problem 23 © CHIDS Data and Images: ADA, CDC, LA Times, IDF Diabetes Atlas “For diabetes in particular, we know there's a relationship between lack of glucose regulation and complications like blindness and kidney failure. So if you were diabetic and you knew that you could get your glucose in a tight, normal range just by adjusting your lifestyle, wouldn't that be great.” - Eric Topol, MD
Notas do Editor
- Concept originated at the University of Maryland. Clinical PI at the School of Medicine… who is now Chief of Endocrinology at Baltimore VA… Software architecture and development team at Fraunhofer USA We have also worked with European to gauge feedback .. Conducted focus groups with system in Germany… and Italian partner used system as a component of a grant opportunity… Dutch firm participated as a partner in the grant…
- Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.
- Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.
- Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.
- Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.
- Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.
- Conducted a pilot trial recruited 29 veteran, 2 dropouts, aged 63 – 86, mean age … over 90 days … Caveat -- Small amount of data with w/ outliers
- Regulatory mode – assessment v. locomotion “Do the right thing” or “Just do it” prevention and promotion behaviors Promotion -- “accentuate the positive.” -- They see their goals as opportunities for gain or advancement. In other words, they are focused on all the great things that will happen for them when they succeed – the benefits and rewards. They “play to win.” When people pursue this kind of “good,” we call it having a promotion focus. … Studies from our lab (and many other labs now) show that promotion-focused people respond best to optimism and praise (Halvorsen, HG) Others tend to see their goals as opportunities to meet their responsibilities and to stay safe. They consider what might go badly if they don’t work hard enough to achieve. They don’t play to win – they play to not lose. They want, more than anything else, to feel secure. When people pursue this kind of “good,” they have what we call a prevention focus … prevention-focused tend to be more driven by criticism and the looming possibility of failure (if, for example, they don’t work hard enough) than by applause and a sunny outlook. Prevention-focused people are often more conservative and don’t take chances, but their work is also more thorough, accurate, and carefully-planned. Of course, too much caution and hypervigilance for error pretty much kills off any potential for growth, creativity, and innovation. But for the prevention-focused, the ultimate “bad” is a loss you failed to stop
- We were generally pleased with the usage for this version, as 70% of patients used 60 days and more than 40% used almost every day You can see some folks never caught on Fitness was the low… glucose was low… underscores the importance of automating data capture
- Can see many of the points came through taking meds. Fitness.
- Across 23 intervention patients (1 dropped at outset)… 73% saw an improvement in A1c 4.9% average reduction in A1c less outliers. The top ½ of patients showed 14.0% decrease in A1C Many patients voiced improved understanding and perceived self-efficacy in diabetes management Features identified for V2.0 – communication, analytics, usability, game design
- Across 23 intervention patients (1 dropped at outset)… 73% saw an improvement in A1c 4.9% average reduction in A1c less outliers. The top ½ of patients showed 14.0% decrease in A1C Many patients voiced improved understanding and perceived self-efficacy in diabetes management Features identified for V2.0 – communication, analytics, usability, game design
- Prevention versus Promotion focused (Playing to Win versus Playing to not Lose) Locomotion versus Assessment Mindset Setbacks Self-Efficacy
- Version 2.0 trial being planned for early 2016 Communication feature upgrades including video-chat Message library New games New visualizations Moving to smartphone as primary platform for patients Control dashboard as web application Future Machine learning and self-adaptive, genetic and environmental data
- <Single animated slide> Diabetes as one of most prevalent and costly of all diseases Diabetes can affect many parts of the body and is associated with serious complications, such as heart disease and stroke, blindness, kidney failure, and lower-limb amputation. Also one of most preventable through behavior change Health issue and financial issue Diabetes directly kills more than 71,000 people a year, according to the American Diabetes Association.