A statistical clinical decision support tool for determining thresholds in remote monitoring using predictive analytics

Statistical process control (SPC) and predictive analytics have been used in industrial manufacturing and design, but up until now have not been applied to threshold data of vital sign monitoring in remote care settings. In this study of 20 elders with COPD and/or CHF, extended months of peak flow monitoring (FEV1) using telemedicine are examined to determine when an earlier or later clinical intervention may have been advised. This study demonstrated that SPC may bring less than a 2.0% increase in clinician workload while providing more robust statistically-derived thresholds than clinician-derived thresholds. Using a random K-fold model, FEV1 output was predictably validated to .80 Generalized R-square, demonstrating the adequate learning of a threshold classifier. Disease severity also impacted the model. Forecasting future FEV1 data points is possible with a complex ARIMA (45, 0, 49), but variation and sources of error require tight control. Validation was above average and encouraging for clinician acceptance. These statistical algorithms provide for the patient's own data to drive reduction in variability and, potentially increase clinician efficiency, improve patient outcome, and cost burden to the health care ecosystem.