The following relates to the medical arts. It finds particular application in remote patient management systems, but is more generally applicable to any remote patient/healthcare interaction system.
It is known that appropriate behavioral modifications can lead to improved medical intervention outcomes and to health enhancement in general. Such behavioral modifications can include, for example, improved diet, quitting smoking, engaging in regularly scheduled exercise, taking scheduled medications, and so forth. Unfortunately, the medical care paradigm in most countries is not well-suited to administering successful behavioral modifications. A patient is likely to see his or her doctor infrequently at best, perhaps on a monthly or more infrequent basis. A person not under treatment for any specific condition is likely to see his or her doctor even more infrequently. For example, in the United States such a person is likely to have an annual physical examination.
Efforts have been made toward developing out-patient medical monitoring and interventional systems. For example, the Motiva® system (Koninklijke Philips Electronics N.V., Eindhoven, The Netherlands) provides Internet-based or other communication network-based tools for managing remote patients in accordance with individualized care plans. Instructional and motivational videos pertaining to health-related topics are provided on a scheduled basis. Feedback on patient progress is obtained by interactive assessment surveys, information retention tests administered after instructional video presentations, transmission of vital signs or patient weight measured at home by the patient, and other tools.
Pilot studies have shown that Motiva® substantially enhances interventional outcomes and improves quality-of-life metrics for patients. However, the long-term success of Motiva® and other remote health management systems is contingent upon continued long-term participation by patients. In this regard, a patient who is upbeat and cheerful is more likely to participate in automated health management, whereas a patient who is depressed or discouraged is less likely to participate. Accordingly, it has been recognized that patient motivation is an important factor in the success or failure of remote patient management.
One approach for motivating patients is to provide rewards for measurable progress along the patient management program. For example, the Internet-based diet planning organization SparkPeople® has instituted a SparkPoints® program that allocates points to participants based on actions such as dietary program compliance, logging into the SparkPeople® website, reading health-related articles, and so forth. The SparkPeople® website displays the scoring leaders who have accumulated the highest number of points, using alias identifications to provide anonymity.
The approach of SparkPeople® has certain disadvantages as a motivational tool. The number of points acquired (numbering in the tens of thousands for scoring leaders) can become so high as to lose motivational significance. The program is also unlikely to be motivational for persons who are doing poorly. Indeed, the lack of points accumulation by less stellar performers, compared with the massively higher point totals of the scoring leaders, can have a demoralizing effect. Problematically, it is precisely those persons who are doing poorly in the program who typically most need a motivational boost. It is likely that the scoring leaders are already highly motivated, and would perform well even without the points incentive.
Indeed, such problems are inherent in existing scoring systems—highly motivated individuals strive to be scoring leaders and thereby receive additional (typically unnecessary) motivation, while unmotivated or unsuccessful individuals become further discouraged by their failure to keep up with the scoring leaders. Making the obtaining of points easier enables unmotivated or unsuccessful individuals to acquire points more easily, but at the expense of devaluing the acquired scores and reducing the overall effectiveness of the points incentive system.
The following provides a new and improved apparatuses and methods which overcome the above-referenced problems and others.
In accordance with one aspect, a patient management system is disclosed, comprising: a scheduler configured to schedule engagements with a patient in accordance with a care plan, the engagements including at least presentation of audio/video content; an audio/video presentation device configured to present audio/video content to the patient as directed by the scheduler; an input device configured to receive patient responses; a response analyzer configured to analyze at least one patient response to determine patient compliance with a goal of the care plan; and an incentives rules engine configured to generate incentives based on the patient compliance, the incentives rules engine adjusting the generated incentives based on at least one additional factor to enhance motivational value of the generated incentives.
In accordance with another aspect, a patient management method is disclosed, comprising: generating a care plan for a patient; engaging the patient in accordance with the care plan, said engaging including at least presenting audio-video content to the patient in accordance with the care plan; quantifying progress of the patient in following the care plan using at least one patient metric; and accumulating incentives based on the at least one patient metric and at least one additional factor selected to enhance motivational value of the accumulating incentives.
In accordance with another aspect, a method for publishing a collection of scores is disclosed, the method comprising: resealing the scores to compress a range of the scores while retaining the ordering of the scores from lowest score to highest score; and publishing the resealed scores.
In accordance with another aspect, a method is disclosed of adjusting an insurance premium assigned to a patient, the method comprising: generating a care plan for a patient; engaging the patient in accordance with the care plan, said engaging including at least presenting audio-video content to the patient in accordance with the care plan; quantifying progress of the patient in following the care plan using at least one patient metric; accumulating incentives based at least on the at least one patient metric; and adjusting the insurance premium assigned to the patient downward by an amount determined based on the accumulated incentives.
One advantage resides in providing incentives-based motivation in remote patient management that is effective for persons performing poorly in the patient care plan.
Another advantage resides in providing incentives-based motivation that is effective for patients who are performing poorly.
Another advantage resides in providing scores publication in a form that does not discourage poor performers, while retaining motivational aspects associated with competition engendered by comparative scores publication.
Another advantage resides in providing incentives-based motivation that is keyed to the mood of the patient.
Another advantage resides in providing incentives-based motivation using a type of incentives that is selected based on a dominant patient characteristic.
Still further advantages of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description.
With reference to
The patient has access to an audio/video presentation device, such as an illustrated television 10, or a cellular telephone with a graphical display, or a personal data assistant (PDA) with a graphical display, or a personal music player having video playback capability, or so forth. In some embodiments, the patient may selectively make use of more than one such audio/video presentation device in accessing the remote patient management system, for example using the illustrated television 10 when at home, but using a cellular telephone when away from home. The audio/video presentation device typically has a primary function separate from the patient management system, and also operates to present audio/video content chosen by the patient management system. For example, the television 10 retains its primary function of presenting broadcast television (optionally supplied via a cable network, satellite network, or so forth) and optionally presenting DVD playback or other non-broadcast content. The television 10 additionally is configured to present content provided by the remote patient management system. Such a dual-functionality audio/video presentation device has advantages such as generally being familiar to the patient, reducing space occupancy, and so forth. However, it is also contemplated for the audio/video presentation device to be a dedicated device that is used solely to present audio/video content provided by the remote patient management system.
The patient also has access to a response input device, such as an illustrated handheld remote controller 12, a keypad of a cellular telephone or PDA, the user interface of a personal music player, or so forth. The response input device has functionality including controlling the audio/video presentation device and providing patient responses to the remote patient management system. Typically, the same response input device is used for both functions—for example, the remote controller 12 may be configured to control the television 10 (such as to select a channel for viewing, change the volume, and so forth) and also to provide patient responses to the remote patient management system. Similarly, the keypad of a cellular telephone may be configured to control the telephone (such as inputting a telephone number to call, changing the speaker volume, and so forth) and also to provide patient responses to the remote patient management system. Using a single device for both functions is typically convenient for the patient; however, it is contemplated to have separate devices for performing control of the audio/video presentation device and for providing patient responses to the remote patient management system. Such a separate arrangement may be more practical for retrofitting an existing television or other audio/video presentation device for operation in conjunction with the remote patient management system. If the audio/video presentation device is a dedicated device used solely to present audio/video content provided by the remote patient management system, then the response input device is typically also a dedicated device.
The remote patient management system is personalized—each patient has an associated patient record 14 which is typically in electronic form, although some portions may additionally or alternatively be in printed form. The patient record typically includes a medical history 16 (which may or may not be complete) and a care plan 18 that provides information on interventional engagements that are scheduled for the patient, along with one or more goals that are intended to be accomplished by such interventional engagement. A scheduler 20 schedules audio/video content for presentation to the patient. The scheduled audio/video content may come from various sources. For example, scheduled content may be retrieved from an audio/video content database 22, containing content such as videos on how to stop smoking, weight loss videos, exercise videos, motivational videos, interactive survey videos, and so forth. Scheduled content may also include personalized audio/video content 24, such as a video message from the patient's doctor, or from a nurse, or so forth. The optional personalized audio/video content 24 advantageously provides the patient with personalized contact with medical professionals. The optional personalized audio/video content 24 optionally may also include personal messages from other persons being assisted by the remote patient management system. Such personal messages are contemplated as tools for establishing support networks amongst patients with similar conditions, as tools to promote socializing of home-bound or otherwise socially isolated patients, and so forth.
The scheduler 20 selects content scheduled for presentation based on the care plan 18. For example, the care plan 18 may include a list of stored content from the database 22 along with a presentation time information that may be absolute (for example, indicating that video “x” should be presented on Dec. 14, 2008) or relative (for example, indicating an ordering of presentation without specific dates or times) or some combination of absolute and relative timing information. Personalized messages from the personalized content database 24 may be pre-scheduled (for example, the doctor may record a message for the patient on a weekly or otherwise scheduled time basis) or extemporaneous (for example, a nurse reviewing the patient's record 14 identifies information that should be given to the patient and records a suitable message). In the extemporaneous case, the message is typically presented as soon as practical.
An audio/video engine 30 handles presentation of the scheduled content. In some embodiments, the audio/video engine 30 has substantial processing capability, for example being embodied as a control box connected with the television 10, and the audio/video engine 30 implements a graphical user interface providing the patient with a menu of options for viewing. In such an arrangement, the available scheduled audio/video content (such as videos, video messages, video surveys, or so forth) are identified to the patient via the graphical user interface, and the patient can select which content to be presented. In other embodiments, the audio/video engine 30 may include less processing capability, and may merely serve as a formatting device or other conduit for channeling the scheduled audio/video content into the television 10 or other presentation device.
It is to be appreciated that the physical and logical layout of the system components can vary. The audio/video presentation device should be in the vicinity of the patient, such as in the patient's home in the case of a television, or typically carried with the patient in the case of a cellular telephone, PDA, portable music player, or the like. The audio/video engine 30 can be located in the patient's home, or located in the presentation device as software executing on a processor of the presentation device (for example, a program executed by the processor of a cellular telephone, PDA, or the like), or located at a remote server that, for example, communicates with the presentation device via the Internet, a cellular telephone network, or the like. The patient record 14 is typically accessible by medical professionals via a computer 32 or other interface located at a hospital, doctor's office, or other medical facility. However, the patient record 14 may be stored at such a medical facility or elsewhere. In some embodiments, the patient record 14 or portions thereof may be stored on a hard disk or other storage of the audio/video engine 30. The various components of the patient record 14 can be physically or logically separate or physically or logically integrated. Thus, for example, the medical history 16 may be stored in a secure hospital database, while the care plan 18 and scheduler 20 may be stored in a dedicated secure server hosting the remote patient management system.
The care plan 18 is suitably constructed by a nurse, doctor, or other medical or administrative person with at least some personalization to the patient. For example, the patient may be identified as a non-smoker, moderately overweight, having a family history of cardiac disease, and having a less than ideal diet. The nurse, doctor, or other medical or administrative person receives this information and constructs the care plan 18 by selecting for presentation pre-recorded modules from the audio/video content database 22 relating to basic operation of the system from the patient end, relating to dieting and cardiac disease prevention, and motivational videos relating to these topics, and schedules these for presentation, preferably interspersed with interactive patient surveys, vital sign measurement request videos, or other interactive modules constructed to elicit patient feedback. The nurse, doctor, or other medical or administrative person optionally further records patient-specific audio/video content such as a welcome message including information on the patient's personal contact at the remote patient management system (optionally this may be the person recording the message), and further inserts this into the care plan schedule. At the specified times, the scheduler 20 conveys the scheduled audio/video content to the audio/video engine 30 for presentation to the patient.
When an interactive survey, vital sign measurement request video, or other interactive module is presented, the patient uses the handheld remote controller 12 or other patient response device to provide the requested feedback. For example, an interactive survey may display a question with a list of several answer options (e.g., “How are you feeling today?” with answer options including “cheerful”, “so-so”, “a bit down”, and “depressed”) and the patient presses “up” and “down” arrow keys on the remote controller 12 to move amongst these selections and presses the “enter” key to make the selection. In the case of a vital sign measurement request video, the patient is requested, for example, to take his or her pulse, and then is asked to enter the measured pulse using the numeric buttons of the handheld remote 12. The resulting patient responses 33 are conveyed to a response analyzer 34, which in
The remote patient management system described with reference to
With continuing reference to
Table 1 shows some illustrative incentive types that are advantageous for patients having various identified characteristics. The selection of the incentive type based on patient characteristic can be advantageous in producing highly motivational incentives. For example, providing incentives in the form of health outcome forecasts can be highly motivational for patients who are fitness enthusiasts having the opinion that they are “in control” and able to improve their own health. For this incentive type, the incentives rules engine 40 suitably computes a health outcome forecast based on the patient metrics and a suitable algorithm or formula relating the patient metrics to statistical patient health outcome forecasts. For example, every five pounds of weight loss may be related to a certain increase in life expectancy. On the other hand, a patient who is a hypochondriac probably should not be reminded of health outcome issues since this may feed the hypochondriac tendency. For the hypochondriac a motivation in the form of “happy face” counters displayed on the audio/video device 10 during patient engagement sessions of the remote health management system may be more motivational. Such displayed “happy face” counters remind the hypochondriac patient that he or she is in fact doing well.
Similarly, incentives in the form of an insurance premium deduction can be highly motivational for patients of limited financial means, but may be less motivational for wealthy patients. A child may find incentives in the form of video game time (suitably “cashed in” by playing a video game via the television 10 and optionally supported by the audio/video engine 30) to be highly motivational, whereas an adult may find such an incentive to have little or no motivational value. As yet another illustrative example, a house-bound patient may find free movie credits (suitably “cashed in” by requesting movies from a cable service provider operating in agreement with the provider of the remote health management system) to be highly motivational. In
The rules applied by the incentives rules engine 40 are selected to enhance motivational value of the generated incentives 42. In some embodiments, the generated incentives are adjusted based on a patient mood profile 44 determined and occasionally updated by a patient mood profiler 46 based on selected portions of the patient responses 33. For example, the presented audio/video content may include a survey including questions designed to elicit information about the patient's mood, and this information is then processed by the patient mood profiler 46 to update the patient mood profile 44. In the illustrated embodiments, patient mood is designated as a parameter ranging from depressed to cheerful; however, more complex representations of patient mood are contemplated, for example to account for the patient's level of hope (for example, represented on a scale between despairing and confident), or to account for a patient's level of social interaction (for example, represented on a scale between isolated and overwhelmed with visitors), or so forth. Other additional factors that may be accounted for in adjusting the generated incentives to enhance motivational value include the accumulated incentives total, sometimes referred to herein as a score 50, and a random factor suitably introduced by a random or pseudorandom number generator 52.
With continuing reference to
The measure of incentives can be binary (for example, the patient either watches the video and receives incentive points, or does not watch and hence receives no points) or can be analog (for example, the amount of incentive points received before any adjustments may be based on the number of pounds of weight that has been lost). Where the goal is analog, it is contemplated to provide some incentive points if the patient is below compliance but close to compliance, as diagrammatically illustrated in
To encourage compliance with goals, the incentives accumulation should sharply increase at the compliance point, as shown in
The incentives accumulated in accordance with
With continuing reference to
With continuing reference to
In some embodiments, once the patient reaches a certain accumulation of incentives, that is, reaches a certain terminal score denoted by Nterm in
On the other hand, in some embodiments there may be provisions made to lower goals with which the patient consistently fails to comply. For example, if the “at compliance” line of
With reference to
With continuing reference to
Some suitable monotonically increasing, concave downward rescaling functions include logarithm-based rescaling functions such as that shown in
Resealed score=A×log(score)+B (1),
where A and B are constants and “log( )” is a logarithmic function, such as a base-10 logarithm (that is, “log10( )”), a natural logarithm (that is, “ln( )”), or so forth. Table 2 shows selected scores and resealed scores for the logarithmic rescaling function of Equation (1) in which the “log( )” function is base ten and A=B=1. As shown in Table 2, the scores range from a low value of 1 to a high value of 20,000, representing a range of four orders of magnitude. One can easily imagine Sally, who has a score of 100, being discouraged by publication of the much higher scores of Matt and Jill at 15,000 and 20,000, respectively. On the other hand, by publishing the resealed scores which range from a low value of 1.00 to a high value of 5.30, Sally is not discouraged because her resealed score of 3.00 is within a reasonable range of the published resealed scores of Matt and Jill at 5.18 and 5.30, respectively.
The logarithmic-based rescaling functions are illustrative examples. Other monotonically increasing, concave downward rescaling functions can be used.
Moreover, the disclosed systems and methods for rescaling of incentives totals before publication are applicable to publication of scores in general, including but not limited to scores corresponding to incentive totals in the context of a remote patient management system. For example, the disclosed systems and methods for rescaling scores may be applied to competitive athletic scores such as finishing times in races, publication of academic grade scores, or so forth. The rescaling advantageously enables publication that engenders competitive motivation, without unduly discouraging those persons having low scores. The rescaled scores retain the ordering of scores so as to foster a desire to improve as compared with peers, interpersonal competition, and other motivational aspects. As illustrated in Table 2, a logarithmic-based rescaling advantageously can compress scores spanning a range of several orders of magnitude into rescaled scores having a range of less than one order of magnitude. On the other hand, where the scores have a smaller range, such as finishing times in a race, a less aggressive monotonically increasing, concave downward rescaling function can be used, such as sqrt(x) where x is the score and sqrt(x) is the square-root of x. The less aggressive sqrt(x) rescaling function has the effect of reducing a score range of about a factor of five to a score range of about a factor of two.
While the rescaled scores are published, each person is optionally informed of his or her score without such rescaling. For example, if the score is reflective of a meaningful quantity, such as a finishing time in a race, the score has meaning that the rescaled score does not.
In the illustrated examples, the accumulating incentives are quantified by the single illustrated patient score 50. In other contemplated embodiments, there may be two or more different scores maintained, to reflect two or more different and distinct goals. For example, one patient score may reflect progress toward quitting smoking, while a separate patient score may reflect progress toward losing weight. The systems and methods disclosed herein are readily applied to such a situation by applying the incentives rules engine 40 to each goal to produce separate, and separately accumulated, incentives. For the correction Wprior, the accumulated incentives total for the quitting smoking goal is used in adjusting the generated incentives for the quitting smoking goal, while the accumulated incentives total for the losing weight goal is used in adjusting the generated incentives for the losing weight goal. In some embodiments, a nurse, doctor, or other medical professional can review the incentives acquired by the patient using the computer 32 or another suitable interface, or can view the mood profile to assess the patient's psychological condition, or can view other aspects of the patient record 14 to assess the patient's condition and progress. In some embodiments, there may be a monetary prize or other valuable award given to the patient for reaching a certain incentives total.
The invention has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be constructed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/IB2008/050318 | 1/29/2008 | WO | 00 | 1/13/2010 |
Number | Date | Country | |
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60890849 | Feb 2007 | US |