JP6892233B2 - 双方向の遠隔的な患者監視および状態管理介入システム - Google Patents
双方向の遠隔的な患者監視および状態管理介入システム Download PDFInfo
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Description
本発明の実施形態は、ユーザの生理学的な状態および状況を遠隔的に監視することにより健康の問題を管理するユーザを支援して、今後の健康状態を予測し個人的な介護管理の助言をリアルタイムに提供する問題を解決する。例えば、ユーザがパニック発現に悩まされ、予測された差し迫るパニック発現を管理するために支援の助言を受信してよい。双方向の遠隔的な健康監視システムは、複数のソースからデータを集めて、ユーザの生理学的データの正確な分析を容易にし、すぐに使用可能な助言を生成してユーザのモバイルデバイスへ送信し得る。健康監視システムは、現段階のモバイルベースの助言を配信するために、パニック発現が起こる前に迫り来るパニック発現を検出してよい。
発明者は、データ収集調査を行い、パニック障害を患う個人に、日々の生活におけるバイタルサインを継続的に監視するウェアラブルデバイスを最長3週間に渡って使用するよう依頼した。調査の参加者は、モバイルアプリケーションを使用して、パニック発作を経験した際に報告した。さらに、調査の参加者は、発作中に経験した症状の重症度に関する情報を報告した。
図1は、本発明の実施形態にしたがって、例示的な双方向の遠隔的な健康監視システム100を図示する図を提示する。双方向の遠隔的な健康監視システム100は、ユーザが規則的な日常の習慣を行いながら場所を問わずに利用し得る、モバイルおよびウェアラブルシステムである。システム100は、個人のウェアラブルデバイスを、パニック発作などの健康の問題にユーザが対処できるようにするモバイルデバイスアプリケーションと組み合わせる。ウェアラブルデバイスは、ユーザに関するリアルタイムの生理学的データを収集し、モバイルアプリケーションと通信する。システムは、ユーザのバイタルサインの変化を監視することにより、差し迫るパニック発作を自動的に検出する。システムは、ユーザがパニック発作の症状を経験していることに気付く1時間前までに起こる生理学的な変化を監視してよい。
図2は、本発明の実施形態にしたがって、双方向の遠隔的な健康監視のためにモデルを生成する例示的なプロセスを図示するフローチャートを提示する。描写されるプロセスは、パニック発現に悩まされるユーザを監視することを目的としており、プロセスを適用して他の生理学的な状態のためにユーザを監視し得る。
データを取得してモデルを訓練するために、発明者は、パニック障害を患いデータ収集の調査に参加するユーザを探した。10人の調査参加者の各々は、パニック発現が起こった際に報告するためにユーザが使用する、対応するモバイルアプリケーションをダウンロードするための指示と共に、ウェアラブルデバイスを受け取った。発明者は、3週間の間できる限りデバイスを装着し、対応するモバイルアプリケーション/ウィジェットを使用してパニック発作を経験した際に報告するよう、ユーザに依頼した。ユーザのモバイル電話のホーム画面に常駐するウィジェットにより、パニック発現の報告が容易になった。参加者はウィジェットをタップして、パニック発現の症状を経験した記録を開始および停止した。発現の完了時に、発明者は、経験した症状の重症度を評価するようユーザに依頼した。全体で、発明者は15個の症状の重症度を、1が最も重症度が軽く5が最も重症度が重い、1〜5の重症度の区分を使用して評価するよう、ユーザに依頼した。
調査に参加した10人の内訳は、女性5人、男性4人、性転換者とされるユーザ1人であった。最低年齢は19歳、最高年齢は53歳であった。最初の10人の参加者のうち3人のユーザは、いかなる生理学的データも記録しなかった。残りの7人のユーザはデータを記録し、7人のうちの4人が、デバイスを装着中に少なくとも1回のパニック発現を報告した。全体で、システムは、19回のパニック発現を対応する生理学的データおよび症状の重症度情報と共に記録した。最小数の報告は、記録されたデータが1回のパニック報告であった任意の個人により作成された。最大数の報告は、1人の個人により作成された12回のパニック報告であった。平均して、各パニック発現は、おおよそ3分40秒続いた。全体で、発明者は623時間42分の生理学的データを収集した。これは、全体で1.26GBの保存領域を必要とした。
双方向の遠隔的な健康監視システムは、分析のためにデータ測定結果の以下のサブセットを使用してよい:心拍数、呼吸数、心拍変動、中核体温、および、活動。ウェアラブルセンサデバイスは、1Hzの割合で各測定をサンプリングした。測定結果は、以下に詳細に説明される。
HR=60/RR interval
R−R間隔は心臓の鼓動間の時間であり、心電図信号からのQRS群におけるRピーク間の間隔により判定される。
ユーザがセンサデバイスを装着すると、収集されたデータのセッションが生じ、コンマ区切り(CSV)ファイル形式で保存されてよい。システムは、症状の重症度のユーザ報告に基づいて、パニック発現を含むか含まないかでセッションをフラグ付けする。一部の実装において、システムは、パニック症状に関するユーザのフィードバックが1つ以上の所定の閾値を超える場合、パニック発現を含むとしてセッションをラベル付けしてよい。システムは、報告されたパニック発現の各々を取り囲むタイムスライスを抽出することにより、パニック発現を含む各セッションを処理してよい。一部の実装において、システムは、タイムスライスごとに71分の持続時間を設定してよく、これは、報告された発現の前の最長60分、発現の最初の1分、および、報告後の残りの10分を含む。システムが、ユーザがパニック発現を報告する前に、生理学的データに値する60分全部を記録しない場合、システムは71分未満のデータを使用してパニック発現を表してよい。
システムは生理学的な状態の情報を生理学的データから推測するので、システムは、物理的な活動を処理して、信号において観測された任意の変化が単に動きアーチファクトによるものではないことを確定する必要がある。物理的な活動を処理するために、システムは、ユーザがパニック発現を経験していない際に収集されたデータから、各ユーザの個々の回帰モデルを構築してよい。
物理的な活動が処理されてデルタ行列が構築されると、システムは変化点分析を適用して、以下の生理学的な変数の各々の時系列データ内で重大な変化を検出する場合がある:
調査において、正のクラスラベル(例えば、パニック発作が報告された)と比較して、負のクラスラベル(例えば、パニック発作が報告されなかった)のインスタンスが多くあった。これは、収集されたデータセットが負のインスタンス側へ歪められたことを意味する。発明者は、歪められたクラスを取り扱うのに異常検出が適しているため、標準的な分類技術の代わりに異常検出を行うことを選択した。
システムは、各々のユーザに別個のデータセットを構築してよく、さらに、データセットを、訓練、検証、および、テストセットに分割してよい。図9は、モデルを訓練すること、閾値パラメータを選択すること、モデルを選択すること、および、訓練、検証、および、テストセットを使用して、選択されたモデルを評価すること、の手順の高レベルな概要を描写する。
システムは、訓練データセットを使用してガウス分布のパラメータを評価することにより、通常モデルを学習してよい。システムは、最尤推定値を使用してガウス分布の平均および分散パラメータを判定してよい。
システムは、検証セットを使用してパラメータεを選択してよい。最初に、システムは、検証セット内の全てのインスタンスのp(x;μ;Σ)の値を判定する。その後、システムは、予測の精度を評価することにより、パラメータεを選択する。システムは、min(p)からmax(p)へ進んでよく、検証セットデータのF1スコアを最大化するεを選択してよい。F1スコアは、
パラメータの選択および通常モデルを判定することに加えて、システムは、さらに、訓練および検証セットを使用して、自動的なモデル選択を行ってよい。システムは、上記の13個の要約統計量の全ての組み合わせを考慮することにより、モデルを選択し得る。全体で、システムは、訓練および検証データで213−1個のモデルを評価してよい。システムは、保持テストセットを使用する評価のF1スコアを最大化するモデルM*を選択してよい。
以下に、調査のために生理学的データを記録した7人のユーザの各々の適合率および再現率の結果を記載する。システムは、ユーザごとに個々のモデルを構築した。ユーザのうち4人が、デバイスを装着している間にパニック発現を報告した。以下の分析は、報告の前に少なくとも15分間の生理学的データを有する全てのパニック発現を含む。この要件は、分析から除去される2つのパニック発現をもたらした。ユーザのうちの3人は、生理学的データを収集したが、パニック発現を報告しなかったか、または、デバイスを装着していない間に発現を報告したか、のいずれかであった。図10は、各ユーザの分析に含まれる非パニックおよびパニックインスタンスの総数を図示する表1000を提示する。図10における全体的なインスタンスから、システムは、訓練、検証、および、保持テストセットを以下のように構築した。
M*={μBR}
M*={ρBR,ρTemp}
M*={μHR}
M*={ρHR,μBR,μHRV,ρTemp}
図18は、本発明の実施形態にしたがって、双方向の遠隔的な健康監視システムにおける例示的なモバイルデバイス1800を提示する。図18において、モバイルデバイス1800は、プロセッサ1802、メモリ1804、および、ストレージデバイス1806を含む。ストレージデバイス1806は、プロセッサ1802により実行されるプログラムを保存する。具体的には、ストレージデバイス1806は、サーバ通信モジュール1808、助言管理モジュール1810、および、生理学的データ受信モジュール1812を、アプリケーション1814および1816など他のアプリケーションと共に保存する。
Claims (4)
- ユーザに対する個人的な健康管理の助言を生成するためのコンピュータが実行する方法であって、
前記ユーザにより装着されるウェアラブルデバイスにより生成される、前記ユーザの生理学的な状態を示す、第1の生理学的データを取得することと、
前記ユーザの予測モデルを前記第1の生理学的データに基づいて生成することであって、
パニック行列および非パニック行列を前記第1の生理学的データから生成すること、
前記ユーザの少なくとも1つの回帰モデルを、前記ユーザがパニック発作なしに物理的な活動を行っている間に取得された第2の生理学的データを使用して生成すること、及び
1つ以上のデルタ行列を前記少なくとも1つの回帰モデルおよび前記パニック行列および非パニック行列を使用して生成することであって、デルタ行列は前記回帰モデルによって算出される物理的な活動の量を伴う生理学的データの期待値と観測された実際の生理学的な値の間の差を表すものとして生成すること、を含むものであることと、
前記ウェアラブルデバイスにより生成されるリアルタイムの生理学的データを取得することと、
前記予測モデルにしたがって、前記リアルタイムの生理学的データを分析することにより予測を生成して前記ユーザの生理学的な状態が閾値パラメータを超えているかどうかを判定することと、
前記閾値パラメータを超えていると判定すると、助言を選択することと、
前記助言メッセージを前記ユーザのモバイルデバイスへ送信することと、
を備える、方法。 - 前記生理学的データにおける各生理学的変数の各々の時系列データ内で変化点を判定して変化点行列を生成することをさらに備える、請求項1に記載の方法。
- コンピュータにより実行されると、前記コンピュータに方法を行わせる命令を保存する持続性コンピュータ可読保存媒体であって、前記方法は、
ユーザにより装着されるウェアラブルデバイスにより生成され、前記ユーザの生理学的な状態を示す、第1の生理学的データを取得することと、
前記ユーザの予測モデルを、前記第1の生理学的データに基づいて生成することであって、
パニック行列および非パニック行列を前記第1の生理学的データから生成すること、
前記ユーザの少なくとも1つの回帰モデルを、前記ユーザがパニック発作なしに物理的な活動を行っている間に取得された第2の生理学的データを使用して生成すること、及び
1つ以上のデルタ行列を前記少なくとも1つの回帰モデルおよび前記パニック行列および非パニック行列を使用して生成することであって、デルタ行列は前記回帰モデルによって算出される物理的な活動の量を伴う生理学的データの期待値と観測された実際の生理学的な値の間の差を表すものとして生成すること、を含むものであることと、
前記ウェアラブルデバイスにより生成されるリアルタイムの生理学的データを取得することと、
前記予測モデルにしたがって、前記リアルタイムの生理学的データを分析することにより予測を生成して前記ユーザの生理学的な状態が閾値パラメータを超えているかどうかを判定することと、
前記閾値パラメータを超えていると判定すると、助言を選択することと、
前記助言メッセージを前記ユーザのモバイルデバイスへ送信することと、
を備える、持続性コンピュータ可読保存媒体。 - 計算システムであって、
1つ以上のプロセッサ、
メモリ、および、
前記1つ以上のプロセッサにより実行されると、前記計算システムに方法を行わせる、保存された命令を保存する前記1つ以上のプロセッサと結合されるコンピュータ可読媒体であって、前記方法は、
ユーザにより装着されるウェアラブルデバイスにより生成される、前記ユーザの生理学的な状態を示す、第1の生理学的データを取得することと、
前記ユーザの予測モデルを前記第1の生理学的データに基づいて生成することであって、
パニック行列および非パニック行列を前記第1の生理学的データから生成すること、
前記ユーザの少なくとも1つの回帰モデルを、前記ユーザがパニック発作なしに物理的な活動を行っている間に取得された第2の生理学的データを使用して生成すること、及び
1つ以上のデルタ行列を前記少なくとも1つの回帰モデルおよび前記パニック行列および非パニック行列を使用して生成することであって、デルタ行列は前記回帰モデルによって算出される物理的な活動の量を伴う生理学的データの期待値と観測された実際の生理学的な値の間の差を表すものとして生成すること、を含むものであることと、
前記ウェアラブルデバイスにより生成されるリアルタイムの生理学的データを取得することと、
前記予測モデルにしたがって、前記リアルタイムの生理学的データを分析することにより予測を生成して前記ユーザの生理学的な状態が閾値パラメータを超えているかどうかを判定することと、
前記閾値パラメータを超えていると判定すると、助言を選択することと、
前記助言メッセージを前記ユーザのモバイルデバイスへ送信することと、
を備える、コンピュータ可読媒体、
を備える、計算システム。
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