Patent Application
20050182664
The present invention is generally related to the field of clinical studies.
The framework for traditional business models for clinical studies has been rather stable over the last few decades. In such a business model, a sponsor (such as a pharmaceutical company which has developed a new drug, for example) paid all participants which performed in the study. At a minimum, these included participating patients and a medical doctor (an investigator) in charge of supervising the patients. In many cases, an investigation or clinical trial site (e.g., a hospital) was additionally included, where one or more investigators was employed.
So called contract research organizations (CROs) further established their services in the workflow chain of clinical studies, in between the sponsor on one end, and the investigator and patients on the other. The CRO often took over the complete management of the clinical study, including all necessary services including, for example, development of study protocol, recruiting patients and investigators and/or investigation sites, contracting the participants, supervising the conductance of the study, collecting and evaluating data, channeling the payment from the sponsor to the participants, etc. Of course, for such services, the CRO received a substantial part of the aforementioned payment for their own services.
When recruiting the patients, the CRO, or even the sponsor, tended to use and still uses crude methods wherein prospective patients fill out forms and are screened as candidates for clinical studies. The data utilized is normally that obtained from the patient himself or herself. Regarding the investigator or investigator/clinical trial site chosen to conduct/monitor/etc. the study, information previously obtained by the sponsor or CRO can be used. However, this is often a slow process which often does not produce an ideal patient, investigator or investigator/clinical trial site.
It was often difficult to maintain patients, for example, for the entire length of the study, or even through important portions of the study. For whatever reasons, the patients were and still are often not part of the entire clinical trial. However, the compliance of study objects in clinical trials directly affects the final size of the study and therefore the quality thereof, and sometimes the accomplishments of the study. After identifying and recruiting the patients, retaining them throughout the complete clinical trial was and still is a challenging task and required high motivation from the patients and/or the investigator. In the past, the only motivation provided was some type of payment or medical benefit.
The present inventors have recognized problems with the traditional clinical study model, and an object of an embodiment of the present application is to improve on the traditional clinical study model, and thus improve the clinical study or clinical study process. One specific object involves improving incentives for patients of a clinical study. In one embodiment, this can include for example, a method of monitoring participation of a patient in at least one clinical trial. This can include collecting data regarding at least one clinical trial for the patient; comparing, using a computer device, the collected data to at least one threshold; and rewarding the patient upon the collected data at least meeting at least one threshold. Further, the collected data may be compared to a plurality of thresholds and the patient may be rewarded each time the collected data exceeds one of the plurality of thresholds. The present inventors have recognized these and other needs for improving a clinical study.
Further, in another embodiment for improving incentives for patients, the method can include a method of monitoring participation of a patient in at least one clinical trial. Such a method can include collecting data regarding at least one clinical trial for the patient; determining, using a computer device, whether or not the patient has complied with at least one criterion of the at least one clinical trial, from the collected data; and rewarding the patient upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Further, in another embodiment for improving incentives for patients, the method can include a method of monitoring participation of a patient in at least one clinical trial. Such a method can include collecting data regarding at least one clinical trial for the patient; determining, using a computer device, whether or not the patient has complied with at least one criterion of the at least one clinical trial; and indicating that the patient is entitled to compensation upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Further, in another embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from an external device and for comparing the collected data to at least one threshold. Further, it can include a device for rewarding the patient upon the collected data at least meeting at least one threshold.
Still further, in yet another embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from at least one external device and for determining whether or not the patient has complied with at least one criterion of the at least one clinical trial, from the collected data. Further, it can include a device for rewarding the patient upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Finally, in still another embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from at least one external device and for determining whether or not the patient has complied with at least one criterion of the at least one clinical trial. Further, it can include a device for indicating that the patient is entitled to compensation upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Other embodiments of the present application may include devices/systems for implementing any of the aforementioned methods, programs adapted to perform any of the aforementioned methods when executed on a computer device, and/or computer readable mediums storing any of the aforementioned programs.
For a full understanding of the nature and advantages of the various aspects of the invention, reference should be made to the detailed description of exemplary embodiments taken in conjunction with the accompany drawings. The detailed description provides only exemplary embodiments of the invention and thus, the claims of the present invention should not be limited as such.
The present invention will become more fully understood from the detailed description of preferred exemplary embodiments given hereinbelow and the accompanying drawings, which are given by way of illustration only and are thus not limitive of the present invention, and wherein:
In one embodiment, the present invention is directed to an improvement on the traditional clinical study model, and thus an improvement of the clinical study or clinical study process. Specifically, in one embodiment, the present invention is directed to improving incentives for patients of a clinical study. This can include for example, a method of monitoring participation of a patient in at least one clinical trial. In such a method, data is collected from at least one clinical trial for the patient. Thereafter, the collected data is compared, using a computer device (a device including a processor for example), to at least one threshold. The threshold can involve, for example, criteria for a clinical study including aspects defined in a clinical study protocol, target performance parameters of the clinical study, etc. The threshold can define acts/milestones/deadlines/etc. for performing/complying with aspects of the study. Finally, the patient may be rewarded upon the collected data at least meeting at least one threshold. The collected data may further be compared to a plurality of thresholds and the patient may be rewarded each time the collected data exceeds one of the plurality of thresholds (e.g. when milestones of the study are met). As such, the patient may be incentivized to continue participation in the study.
The criteria/thresholds/acts/milestones/deadlines/etc. for performing/complying with aspects of the study and clinical data may be obtained from the sponsor 220 and/or the CRO 230; and patient data may be obtained from existing clinical IT infrastructure including, but not limited to any of the clinical workflow management system 210, electronic patient records (EPR) 212, hospital information systems (HIS) 214 (or any other type of clinical IT infrastructure and/or database) as shown in
Clinical data can include data stored in a database of existing clinical IT infrastructure, such as an electronic healthcare database, for example. This can include, but is not limited to at least one of a database with electronic patient records, a database of clinical workflow management system, information from a hospital IT system (financial or clinical), information from a laboratory or radiology information system, information from a picture archiving and communication system (PACS), information from a physician's IT system, for example, etc.
As shown in
The analytical device 200 then may derive rules from the criteria. These rules may include, but are not limited to, rules which help determines threshold(s)/milestone(s) compliance/reward(s)/timeliness/qualitative measures/quantitative measure/protocol requirement(s)/weighting for reward(s), threshold(s), milestone(s)/etc. The rules which may be applied to check results/data from a clinical study for their compliance with the criteria (threshold/milestone/etc.). These rules may be converted (if necessary) by the analytical device 200 into a machine-readable form, which can then be interfaced to and understood by, for example, the clinical workflow management system. Then, the rules may be applied, for example, for all patients with Ids contained in the patient ID data base (corresponding to patients participating within the clinical study); may be applied to check results of patient actions involving these patients for there compliance with the criteria (meeting a threshold/milestone requirement, etc.).
The analytical device 200 is able to access and analyze clinical data, such as that stored in any of the clinical workflow management system 210, EPR 212, HIS 214 (or any other type of clinical IT infrastructure and/or database). This analytical device 200 connects or is otherwise networked to, and can thereby access/receive/obtain and then analyze clinical data of patients participating in a study from any of the clinical workflow management system 210, EPR 212, HIS 214 (or any other type of clinical IT infrastructure and/or database). The analytical device 200 may further be networked or otherwise connected to the sponsor 220, the clinical study SOP database 280 and/or the CRO 230. The analytical device 200 can then receive or otherwise obtain criteria for a clinical study from the sponsor 220, clinical study SOP database 280 and/or CRO 230 and can then analyze the obtained clinical data in conjunction with (or based upon) the obtained criteria (rules/thresholds/milestones/etc.) for a clinical study. The analytical device 200 can further optionally be connected to at least one external device 270 used by the patient (such as a drug dispenser, for example, with a built in sensor, processor and communication module); and/or to an additional storage 260 (for storing points/reward information for patients, for example).
The analytical device 200 of an embodiment of the present application is then able to correlate and/or compare the clinical data collected from at least one clinical trial for the patient to (or based upon) the obtained criteria for a clinical study (at least one threshold, which could be a milestone for example), and can then reward the patient upon the collected data at least meeting the at least one threshold.
Alternatively or in addition thereto, the analytical device 200 is able to collect data and use the compared information to monitor the patients involved in the clinical study for at least one the clinical trial site. Thereafter, the analytical device 200 can determine whether or not the patient has complied with at least one criterion of the clinical trial (such as a milestone, threshold, etc.) and can then indicate that the patient is entitled to compensation upon determining that the patient has complied with at least one criterion of the clinical trial (e.g. has reached a milestone, for example).
Initially, the analytical device 200 obtains criteria for the clinical study, which may include at least one protocol for the clinical study for example. This can be achieved by accessing the clinical study “standard operating procedure” (SOP) information from a database 280, for example. The criteria for the clinical study may be translated into rules which are machine-readable by the clinical workflow management system 210 for example and/or other aspects of the analytical device 200, wherein applicable criteria may be selected from the database 200 using a graphical user interface, for example. Alternatively, the criteria for the clinical study may be automatically translated into rules which are machine-readable by the clinical workflow management system 210 for example, or by other aspects of the analytical device 200 including at least one of a look-up table, a thesaurus, an ontology, etc. Further, the criteria for the clinical study may be translated into rules which are machine-readable, wherein applicable criteria are selected from a database.
As shown in
Clinical data of a plurality of clinical trial or investigation sites/patients/investigators/etc., and the obtained criteria, may be further analyzed to determine rewards/milestones/thresholds across or using multiple clinical trial or investigation sites, which meet or exceed target/milestone/threshold/etc. compliance with the obtained criteria. As such, plural patients/clinical trial sites/investigators/etc may be ranked accordingly. This ranked information can then be output or otherwise sent to the sponsor 220 and/or CRO 230 for use in determining desired patients/clinical trial sites/investigators/etc. for continued use and/or termination regarding the clinical study.
“Criteria”, as referenced throughout the embodiments of the application, refers to clinical study criteria. These “criteria” are important aspects of the clinical study. These criteria of the study can be used by the analytical device 200. Thus, the criteria outline key or other important aspects (milestones/thresholds/etc. and what is necessary to meet such milestones/thresholds/etc.) of the study which, when provided and correlated/compared with clinical data, can help produce measures of compliance of the clinical study that can be used, for example, to monitor patients of at least one clinical study and even reward or indicate entitlement to compensation.
Some non-limiting examples of “criteria” may include, but are not limited to e.g.:
Often, elements relating to these “criteria” cannot be measured directly, but must be deduced from other measurable parameters or clinical data, and perhaps from a combination of other measurable parameters or other measurable clinical data. This may include volatile data which may be entered and/or stored for only a short time, and later deleted or erased. For example, the exact time as to when a patient has taken a drug or eaten his meal is usually not measured and recorded by a nurse. However, this time is typically recorded in the Clinical Workflow Management System when the drug and the meal are scheduled for delivery to the patient. Therefore, the criterion “pre-prandial medication” can at least, to some certainty, be indirectly deduced from the two database entries including “Scheduled time for drug delivery to patient” and “Scheduled time for meal delivery to patient”, provided that the patient has taken medication and is eating meals immediately after delivery.
As such, an attempt may be made to correlate/compare volatile clinical data with criteria for the clinical study. If so, the volatile data may be permanently stored upon determining a correlation and/or a lack of correlation. Also, volatile clinical data may be correlated with criteria for the clinical study, and the volatile data may be permanently stored upon determining that the measure of compliance is at/below/or exceeds a threshold. Further, clinical data may be stored permanently, upon determining that the data relate to a patient enrolled in the clinical study.
Thus, the analytical device 200 can, for example, build an empirical database for use in such situations, which contains rules on how to combine measurable indirect criteria in order to derive from these, a probability that a non-measurable criterion is met. Accordingly, the analytical device 200 can create a type of mathematical formula or weighting factors regarding the combining of several direct and indirect aspects of the criteria into a weighted combination. Most likely, this formula will include a weighted sum or weighted product of a single criteria. This can then be correlated with existing clinical data from the clinical IT infrastructure to derive a measure of compliance and/or to monitor a patient of at least one clinical study for at least one clinical trial site, for example.
In one aspect of one embodiment, information or contracts which regulate the amounts of payment upfront, between the sponsor on one side and the CRO 230, and/or investigator, and/or patient on the other side, may be based on organizational milestones. In the past, the clinical trial business models did not make use of clinical IT infrastructure and databases, such as electronic patient records (EPR 212), hospital information systems (HIS 214) or clinical workflow management systems 210. In an embodiment of the present application, such clinical IT infrastructure and databases, storing various types of clinical data, are utilized in connection with obtained criteria for the clinical study, to derive performance measures of the study, which can then be used to improve the study (and/or the clinical study business process).
Thus, an incentive system may be introduced for all participants in a clinical trial. Such a system can reward and then track earned points, for example “trial points” (that can be used toward rewards). These points, in the form of a reward, can then be stored in EPR 212, additional storage 260, etc. and then accumulated and tracked for greater rewards.
For the patient, the investigator and optionally other stakeholders (this can include, for example: CRA or Clinical Research Associate; this can be a person employed by the study sponsor or CRO to monitor a clinical study at all participating sites; a research/study nurse, who can be the person who assists the investigator in the administrative coordination of the clinical trial; investigator, who can be a person responsible for the conduct of the clinical trial at a trial site. If a trial is conducted by a team of individuals at a trial site, the investigator may be the responsible leader of the team and may be called the principal investigator; sponsor, who can be an individual, company, institution, or organization which takes responsibility for the initiation, management, and/or financing of a clinical trial; site, which can be the location(s) where trial-related activities are actually conducted, etc.) the criteria for the rewarding are defined, e.g. by the sponsor. The reimbursement/incentive model is preferably translated into rewarded abstract currency trial points. A trial points account may be established for each patient to accumulate the points.
Additional criteria for earning trial points can be defined optionally (e.g. a certain amount for each visit of the investigator may results in points for the patient and the investigator). Many of the processes that support a better compliance of the patient and the investigator may be coupled with ‘earning points’. Thus, both the investigator and patient may earn points.
A tool for optimization of a payment scheme may be used, which takes variables like milestone times, percentage of payments per milestone and stakeholder, value of results achievement at each milestone, incurred cost etc. as an input, and automatically calculates a cost/benefit-optimized payment plan. Everyone who is entitled to earn points may further be able to check an account continuously and can preferably cash out and/or receive other benefits (financial investments: shares, funds; gift coupons at stores, etc.)—optionally linked to requirements such as a limit of points, etc. This may be achieved, for example, by analytical device 200 in conjunction with EPR 212, additional storage 260, etc.
“Corporate Currency” may also be used for “volatile” patients or paramedic personal, but is not preferred for Investigators or sites. Additional features of a corporate currency model that might attract patients to enroll and retain in study can include, but are not limited to an option to trade trial points on a market place; patients with a certain number of trial points may be treated like preferred customers and may be offered special treatments or other healthcare services. In order to authorize milestones as passed, a data infrastructure and network as shown in
Milestones may optionally also lead to penalties instead of payments, if defined thresholds are not achieved. A penalty may be subtraction of points, a freeze of an account, total loss of an account, etc. for example.
Various technical infrastructures can be used to communicate the successful accomplishment of a trial process step to the trial points account in addition to, or in conjunction with the structure of
A goal of an embodiment of the present application is to improve the compliance of patients, investigators and optionally other stakeholders in a clinical trial (CRA, etc.) by coupling an incentive system to crucial trial process steps (such as medication taken by the patient, surgery performed on the patient, etc.). This allows a more direct control of each one over the (financial) reimbursement for the participation in the clinical trial. In his model, there is at least one participant paying for the incentives (sponsor) and there are many incentive recipients—ordered by responsibility. These can include, but are not limited to:
The incentives may be paid, for example, only for results presented in a pre-determined time frame. A substantial fraction of the incentives may be held back until the complete trial is finished successfully. Thus, payment milestones (as shown in
Further, in another embodiment for improving incentives for patients, the method can include a method of monitoring participation of a patient in at least one clinical trial. Such a method can include collecting data regarding at least one clinical trial for the patient; determining, using a computer device such as analytical device 200 for example, whether or not the patient has complied with at least one criterion of the at least one clinical trial, from the collected data; and rewarding the patient upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Further, in another embodiment for improving incentives for patients, the method can include a method of monitoring participation of a patient in at least one clinical trial. Such a method can include collecting data regarding at least one clinical trial for the patient; determining, using a computer device such as analytical device 200 for example, whether or not the patient has complied with at least one criterion of the at least one clinical trial; and indicating that the patient is entitled to compensation upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Further, for any of the above-mentioned embodiments, data collection may be enhanced by leveraging the existing communication and data exchange infrastructure (as shown in
In addition, for any of the above-mentioned embodiments, threshold may include any milestone, etc. and can include, but is not limited to, a number of patient visits during a clinical trial, any and/or all activities of a patient in a study that can be influenced by the patient, etc.
In addition, for any of the above-mentioned embodiments, a clinical study may include on in which the patient needs to take a medication periodically. As such, a drug dispenser may be used (shown a external device 270 of
Further, for any of the above-mentioned embodiments, timeliness may be included as a criteria for reaching a threshold/milestone/etc. For example, timeliness can involve comparing the time/date of the patient visits with timelines dictated by the study protocol.
Further, for any of the above-mentioned embodiments, the thresholds/milestones/etc. may be correlated/ranked/weighted by importance of the actions for a clinical trial. It might be crucial to have the second patient visit in a time frame of two days, for example, where otherwise the study protocol would enforce a dropout. Thus, weighting of actions in a clinical study may influence a number of points given/reward given for compliance wherein compliance with certain important criteria of the clinical study may be weighted more heavily and result in more points than compliance with other criteria (which may result in even less or no points, and/or which may results in no points/rewards given for the patient for the entire clinical trial).
One non-limiting example of an embodiment of the present application is shown in
After showing up in time at the second visit, the patient is credited with more points at milestone 2 (reaching a next threshold or milestone as defined by the study). Thereafter, by reaching other thresholds, such as by showing the investigator the completed patient diary (completed between first and second visit), the patient may then be credited with more points.
After the second visit, the patient may need to take a medication regularly until the third visit. A drug dispenser with a built-in sensor and processor may be used to detect a date of removal of a drug and may stores this information. At the third visit, the drug dispenser (connected to the analytical device 200 for example) may then be used such to retrieve information (e.g. the analytical device 200 may read the time stamps from the drug dispenser and compare this with the clinical trial protocol that defines what amount of medication needs to be taken, and when). Again points may then be further credited to the patient account at milestone 3 if every removal of a drug was timely (if this additional conditional threshold/milestone was met). At the end of the study, the patient receives n points for finishing it at milestone n. The points can be accumulated, stored in EPR 212/additional storage 260/etc. and can traded in for incentives, etc.
The assignee of the present application has further been involved in various other inventions regarding clinical studies, and in some cases the use of clinical IT infrastructure, in order to improve the development of clinical study business models and/or the development of clinical study protocols; improving the effectiveness of patient recruiting; controlling the compliance of clinical study protocol rules; etc. The entire contents of each of the following applications is hereby incorporated by reference in the present application:
Thus, it should be understood that
Each of the various embodiments discussed above can include the use of weighting factors. For example, the clinical study criteria obtained can include weighing factors, wherein the weighting factors may reflect a likelihood of the “criteria” to correlate with direct benefit, such as a financial benefit to someone/something, for example. The rewarding/indicating entitlement of compensation may be based upon one or more weighting factors. With regard to clinical study criteria such as study duration, costs, study result reliability, major “criteria” which may help to influence these measures positively may include, but are not limited to:
Often, these “criteria” cannot be measured directly, but must be deduced from other measurable parameters, and perhaps from a combination of other measurable parameters. Thus, the analytical device 200 may, for example, build an empirical database on typical “dropout” rates of patients, wherein these rates might vary with investigation sites, patient's age, geography, etc. Thus, the analytical device 200 can create a type of mathematical formula or weighting factors regarding the combining of several direct and indirect criteria into a prediction of probable benefit, such as probable financial benefit to the sponsor/investigator/etc. Most likely, this formula will include a weighted sum or weighted product of the single criteria. Accordingly, an output reward may be derived based upon weighted determinations using the weighing factors.
Any of the aforementioned embodiments described in the form of methods may be embodied in the form of a system or device, including, but not limited to, any of the structure for performing the methodology illustrated in the drawings. In one embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from an external device and for comparing the collected data to at least one threshold. Further, it can include a device for rewarding the patient upon the collected data at least meeting at least one threshold.
Still further, in yet another embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from at least one external device and for determining whether or not the patient has complied with at least one criterion of the at least one clinical trial, from the collected data. Further, it can include a device for rewarding the patient upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Finally, in still another embodiment, an apparatus for monitoring participation of a patient in at least one clinical trial can include at least one device for collecting data regarding at least one clinical trial for the patient from at least one external device and for determining whether or not the patient has complied with at least one criterion of the at least one clinical trial. Further, it can include a device for indicating that the patient is entitled to compensation upon determining that the patient has complied with at least one criterion of the at least one clinical trial.
Further, any of the aforementioned methods may be embodied in the form of a program. The program may be stored on a computer readable media and is adapted to perform any one of the aforementioned methods when run on a computer device (a device including a processor). Thus, the storage medium or computer readable medium, is adapted to store information and is adapted to interact with a data processing facility or computer device to perform the method of any of the above mentioned embodiments.
The storage medium may be a built-in medium installed inside a computer device main body or a removable medium arranged so that it can be separated from the computer device main body. Examples of the built-in medium include, but are not limited to, rewriteable involatile memories, such as ROMs and flash memories, and hard disks. Examples of the removable medium include, but are not limited to, optical storage media such as CD-ROMs and DVDs; magneto-optical storage media, such as MOs; magnetism storage media, such as floppy disks (trademark), cassette tapes, and removable hard disks; media with a built-in rewriteable involatile memory, such as memory cards; and media with a built-in ROM, such as ROM cassettes.
Exemplary embodiments being thus described, it will be obvious that the same may be varied in many ways. Such variations are not to be regarded as a departure from the spirit and scope of the present invention, and all such modifications as would be obvious to one skilled in the art are intended to be included within the scope of the following claims.
The present application hereby claims priority under 35 U.S.C. §119 on U.S. provisional patent application No. 60/545,170 filed Feb. 18, 2004, the entire contents of which are hereby incorporated herein by reference.
| Number | Date | Country | |
|---|---|---|---|
| 60545170 | Feb 2004 | US |
