Post-hospital-discharge COPD-patient monitoring using a dynamic baseline of symptoms/measurement

• US 10,327,711 B2
• Filed: 03/05/2014
• Issued: 06/25/2019
• Est. Priority Date: 03/18/2013
• Status: Active Grant

• Current Assignee: Koninklijke Philips N.V.
• Original Assignee: Koninklijke Philips N.V.
• Inventors: Sachdev, Birpal Singh, Murdoch, Robert William
• Primary Examiner(s): Natnithithadha, Navin
• Assistant Examiner(s): Shostak, Andrey
• Application Number:
  US14/776,032
• Publication Number:
  US 20160029971A1
• Time in Patent Office: 1,938 Days
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/7271 Specific aspects of physiological measurement analysis A61B5/316, A61B5/349 and A61B5/374 take precedence
• CPC Class Codes: A61B 5/746 Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms alarms per se G08B
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients

Abstract

Systems and methods for monitoring subjects after discharge from a hospital use a dynamic baseline to determine whether a caregiver needs to be notified regarding exacerbation of a medical state of a subject. The subjects are chronic obstructive pulmonary disease (COPD) patients. The dynamic baseline is determined by aggregating (for example averaging) multiple values of a sequence of values for a metric that quantifies one or both of a patient symptom (e.g. the number of overnight apnea occurrences) and/or lung function of a subject (e.g. forced expiratory volume in 1 second). Multiple metrics may be combined to generate the value that is monitored for a subject.

Claims

1. A system configured to detect exacerbations based on dynamically-updated threshold values, the system comprising:

one or more hardware processors configured by machine readable instructions to;

obtain a sequence of values for a metric that quantifies a lung-related characteristic of a subject, each value of the sequence corresponding to a time during a defined period different from a time to which at least another value of the sequence corresponds;

determine, based on a set of values of the sequence, a dynamic threshold for the subject;

adjust the dynamic threshold for the subject multiple times during the defined period based on other sets of values of the sequence, wherein each of the other sets of values includes at least one particular value that is not included in another set of values of the sequence, wherein a quantity of values in an individual set is inversely proportional to a duration of time that corresponds to the individual set;

compare one or more values of the metric to the multiple-adjusted dynamic threshold;

responsive to the comparison indicating exacerbation of a medical state of the subject, temporarily hold a current level of the multiple-adjusted dynamic threshold constant for a period of time; and

provide a notification to a caregiver based on a comparison of one or more additional values of the metric with the temporarily held current level of the multiple-adjusted dynamic threshold, wherein the notification indicates an ongoing exacerbation of the medical state of the subject.

2. The system of claim 1, wherein the defined period is between 8 hours and 48 hours.

3. The system of claim 1, wherein the one or more hardware processors are further configured such that providing the notification to the caregiver is based on whether a difference between one or more individual values of the additional values for the metric and the temporarily held current level of the multiple-adjusted dynamic threshold breaches a duration threshold.

4. The system of claim 1, wherein the one or more hardware processors are further configured to:

determine variability of multiple individual values for the metric, such that a variability is determined of multiple individual values for the metric; and

determine static thresholds for subjects, such that a static threshold is determined for the subject by aggregating multiple individual values for the metric, wherein determination of the static threshold is based on the variability,

wherein providing the notification to the caregiver is based on a comparison of one or more individual values of the metric and the static threshold.

5. The system of claim 1, further comprising one or more sensors configured to generate output signals conveying information related to one or more parameters associated with one or both of a patient symptom related to chronic obstructive pulmonary disease (COPD) and/or lung function of the subject, wherein the sequence of values for the metric is obtained based on the output signals generated by the one or more sensors.

6. The system of claim 1, wherein the one or more hardware processors are further configured to obtain a second sequence of values for a second subject, determine a second multiple-adjusted dynamic threshold for the second subject, determine whether the caregiver needs to be notified regarding exacerbation of a medical state of the second subject, and

compare progression of medical states between the subject and the second subject spanning a period of at least a year, wherein the comparison is based on determinations of whether the caregiver needed to be notified regarding exacerbation of the medical state of the subject and the second subject during the year.

7. The system of claim 1, wherein the one or more hardware processors are configured to temporarily hold the current level of the multiple-adjusted dynamic threshold constant until one or more of the one or more additional values of the metric breach the temporarily held constant current level of the multiple-adjusted dynamic threshold.

8. A method for detecting exacerbations based on dynamically-updated threshold values with an exacerbation detection system, the system comprising one or more hardware processors configured by machine readable instructions, the method comprising:

obtaining, with the one or more hardware processors, a sequence of values for a metric that quantifies a lung-related characteristic of a subject, each value of the sequence corresponding to a time during a defined period different from a time to which at least another value of the sequence corresponds;

determining, with the one or more hardware processors, based on a set of values of the sequence, a dynamic threshold for the subject;

adjusting, with the one or more hardware processors, the dynamic threshold for the subject multiple times during the defined period based on other sets of values of the sequence, wherein each of the other sets of values includes at least one particular value that is not included in another set of values of the sequence, wherein a quantity of values in an individual set is inversely proportional to a duration of time that corresponds to the individual set;

comparing, with the one or more hardware processors, one or more values of the metric to the multiple-adjusted dynamic threshold;

responsive to the comparison indicating exacerbation of a medical state of the subject, temporarily holding, with the one or more hardware processors, a current level of the multiple-adjusted dynamic threshold constant for a period of time; and

providing, with the one or more hardware processors, a notification to a caregiver based on a comparison of one or more additional values of the metric with the temporarily held current level of the multiple-adjusted dynamic threshold, wherein the notification indicates an ongoing exacerbation of the medical state of the subject.

9. The method of claim 8, wherein the defined period is between 8 hours and 48 hours.

10. The method of claim 8, wherein providing the notification to the caregiver is based on whether a difference between one or more individual values of the additional values for the metric and the temporarily held current level of the multiple-adjusted dynamic threshold breaches a duration threshold.

11. The method of claim 8, further comprising:

determining, with the one or more hardware processors, a variability of multiple individual values for the first metric; and

determining, with the one or more hardware processors, a static threshold for the subject by aggregating multiple individual values for the metric, wherein determination of the static threshold is based on the variability, wherein providing the notification to the caregiver is based on a comparison of one or more individual values of the metric and the static threshold.

12. The method of claim 8, wherein the system further comprises one or more sensors configured to generate output signals conveying information related to one or more parameters associated with one or both of a patient symptom related to chronic obstructive pulmonary disease (COPD) and/or lung function of the subject, the method further comprising:

generating, with the one or more sensors, the output signals conveying information related to one or more parameters associated with one or both of the patient symptom related to COPD and/or lung function of the subject, wherein the sequence of values for the metric is obtained based on the output signals.

13. The method of claim 8, further comprising:

obtaining, with the one or more hardware processors, a second sequence of values for the metric that quantifies one or both of a patient symptom and/or lung function of a second subject, wherein individual values in the second sequence correspond to different times, such that individual values in the second sequence correspond to times during a period between 8 and 48 hours;

determining, with the one or more hardware processors, a second multiple-adjusted dynamic threshold for the second subject by aggregating multiple individual values of the second sequence, the second multiple-adjusted dynamic threshold being based on between 4 and 20 individual values;

determining, with the one or more hardware processors, whether the caregiver needs to be notified regarding exacerbation of a medical state of the second subject, wherein the determination is based on a comparison of one or more individual values for the metric from the second subject and a second multiple-adjusted dynamic threshold that is constant for a second period of time; and

comparing, with the one or more hardware processors, progression of medical states between the subject and the second subject spanning a period of at least a year, wherein the comparison is based on determinations of whether the caregiver needed to be notified regarding exacerbation of the medical states of the subject and the second subject.

14. The method of claim 8, wherein the one or more hardware processors are configured to temporarily hold the current level of the multiple-adjusted dynamic threshold constant until one or more of the one or more additional values of the metric breach the temporarily held constant current level of the multiple-adjusted dynamic threshold.

15. A system configured to detect exacerbations based on dynamically-updated threshold values, the system comprising:

means for obtaining a sequence of values for a metric that quantifies a lung-related characteristic of a subject, each value of the sequence corresponding to a time during a defined period different from a time to which at least another value of the sequence corresponds;

means for determining, based on a set of values of the sequence, a dynamic threshold for the subject;

means for adjusting the dynamic threshold for the subject multiple times during the defined period based on other sets of values of the sequence, wherein each of the other sets of values includes at least one particular value that is not included in another set of values of the sequence, wherein a quantity of values in an individual set is inversely proportional to a duration of time that corresponds to the individual set;

means for comparing one or more values of the metric to the multiple-adjusted dynamic threshold;

responsive to the comparison indicating exacerbation of a medical state of the subject, means for temporarily holding a current level of the multiple-adjusted dynamic threshold constant for a period of time; and

means for providing a notification to a caregiver based on a comparison of one or more additional values of the metric with the temporarily held current level of the multiple-adjusted dynamic threshold, wherein the notification indicates an ongoing exacerbation of the medical state of the subject.

16. The system of claim 15, wherein the defined period is between 8 hours and 48 hours.

17. The system of claim 15, wherein operation of the means for providing a notification to the caregiver is based on whether a difference between one or more values of the additional values of the metric and the temporarily held current level of the multiple-adjusted dynamic threshold breaches a duration threshold.

18. The system of claim 15, further comprising:

means for determining a variability of multiple individual values of the metric; and

means for determining a static threshold for the subject by aggregating multiple individual values of the metric, wherein determination of the static threshold is based on the variability, wherein operation of the means for providing a notification to the caregiver is based on a comparison of one or more individual values of the metric and the static threshold.

19. The system of claim 15, further comprising:

means for generating output signals conveying information related to one or more parameters associated with one or both of a patient symptom related to chronic obstructive pulmonary disease (COPD) and/or lung function of the subject, wherein operation of the means for obtaining the sequence of values for the first metric is based on the output signals.

20. The system of claim 15, wherein the means for obtaining the sequence is further configured to obtain a second sequence of values for the metric that quantifies one or both of a patient symptom and/or lung function of a second subject, wherein individual values correspond to different times, such that individual values in the second sequence correspond to times during a period between 8 and 48 hours,

wherein the means for determining the dynamic threshold is further configured to determine a second multiple-adjusted dynamic threshold for the second subject by aggregating multiple individual values of the second sequence, the second multiple-adjusted dynamic threshold being based on between 4 and 20 individual values,

wherein the means for providing the notification to the caregiver is further configured to determine whether the caregiver needs to be notified regarding exacerbation of a medical state of the second subject, wherein the determination is based on a comparison of one or more individual values of the metric from the second subject and a second multiple-adjusted dynamic threshold that is held constant for a second period of time, the system further comprising:

means for comparing progression of medical states between the subject and the second subject spanning a period of at least a year, wherein the comparison is based on determinations of whether the caregiver needed to be notified regarding exacerbation of the medical state of the subject or the second subject during the year.