To e↵ectively 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 su ciently slow progression). Our research addresses these questions simultaneously and optimally by employing linear quadratic Gaussian state space systems modeling and optimal control of measurement adaptive systems. For the new quadratic objective of minimizing disease progression over time, 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 found that fast-progressing patients, who are most at risk for disease progression, show an average of 38% to 58% less loss of peripheral vision per year, leading to 21% to 32% better quality of vision after 10 years when compared to existing treatment controls attained in the clinical trials. This methodology can be applied to a broad range of chronic diseases to optimally devise patient-specific monitoring and treatment plans.
Read full abstract