Dynamic Monitoring and Control of Irreversible Chronic Diseases with Application to Glaucoma

Abstract

To effectively manage chronic disease patients, clinicians must know (1) how to monitor each patient (i.e., when to schedule the next visit and which tests to take), and (2) how to control the disease (i.e., what levels of controllable risk factors will sufficiently slow progression). Our research addresses these questions simultaneously and provides the optimal solution to a novel linear quadratic Gaussian state space model. For the new objective of minimizing the relative change in state over time (i.e., disease progression), which is necessary for management of irreversible chronic diseases, we show that the classical two-way separation of estimation and control holds, thereby making a previously intractable problem solvable by decomposition into two separate, tractable problems while maintaining optimality. The resulting optimization is applied to the management of glaucoma. Based on data from two large randomized clinical trials, we validate our model and demonstrate how our decision support tool can provide actionable insights to the clinician caring for a patient with glaucoma. This methodology can be applied to a broad range of irreversible chronic diseases to optimally devise patient-specific monitoring and treatment plans.