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The development and feasibility of a personal health-optimization system for people with bipolar disorder

机译：躁郁症患者个人健康优化系统的开发和可行性

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Background People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. Methods Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. Results Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean?±?SD (median) system usability score of the patient-oriented subsystem was 71?±?18 (73). The mean?±?SD (median) system usability score in the summative usability testing was 78?±?18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines. Conclusion We have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient’s health on a shared platform. User tests indicate that the feasibility of the system is acceptable.
机译：背景技术患有躁郁症的人经常会身体不适，预期寿命大大缩短。次优的治疗很常见，包括缺乏有效的药物，过度治疗以及不遵守医学干预措施和生活方式措施。电子医疗和移动医疗的应用支持患者优化治疗，但常常表现出概念和技术上的缺陷。这项工作的目的是开发和测试针对次优治疗系统的可用性，并将服务与其他类型和策略进行比较。方法基于共享决策，多标准决策分析和单主题研究设计的框架，我们采访了潜在用户，回顾了研究和当前方法，并使用快速原型框架创建了第一个版本。然后，我们根据患者，医疗保健提供者以及来自挪威，英国和乌克兰的非专业人员的格式化可用性测试，反复改进和扩展了该服务。基于证据的健康优化系统是使用系统方法开发的。在形成性和汇总性测试中管理系统可用性量表和问卷。将该系统与当前临床实践指南和患者决策辅助标准进行了比较。结果78位潜在用户确定了82个问题。在用户反馈的推动下，有限的第一个版本被开发为更全面的系统。当前版本包含21个集成的核心功能，支持6种健康优化策略。一项重要功能使患者和临床医生能够根据自我报告和研究数据的数学整合以及患者的偏好来探索治疗的可能价值。以患者为导向的子系统的平均系统可用性得分为±±SD（71）±18（73）。在汇总可用性测试中，系统可用性中位数的平均值为±78，平均值为±78（75），远高于正常分数68。调查问卷的反馈通常为阳性。在国际标准中，患者决策辅助工具和临床实践指南不需要系统中23个组件中的18个。结论我们开发了首个基于证据的健康优化系统，使患者，临床医生和护理人员可以在共享平台上协作优化患者的健康状况。用户测试表明该系统的可行性是可以接受的。

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