1. Technology Working Group Meeting
ERS 2017
Milan, 9th September 2017

2. Agenda Working group progress update Priorities for future research
Review potential studies
Are they still relevant, feasible, valid and a priority
Other research ideas
Setting priorities
Additional items

3. Attendees
John Blakey (chair – dial in) K F Chung Nicholas Roche Ron Dandurand Danny McBryan Heather Hoch

4. Progress update Published papers
Effective deployment of technology-supported management of chronic respiratory conditions: a call for stakeholder engagement, Pragmat Obs Res 2017
Use of electronic medical records and biomarkers to manage risk and resource efficiencies, Eur Clin Respir J 2017

5. Active study update (1)
REG_P41: Predicting the risk of future asthma exacerbations in a claims-based healthcare system
Protocol complete
Objective
Use claims-based healthcare data to
Characterise the frequent exacerbator subgroup of asthma patients.
Identifying individual risk factors (demographic and clinical) and exploring clusters of risk factors associated with increased future exacerbation risk
Validate REG’s UK Asthma Risk Prediction model, using administrative health data to identify patients at increased risk of future exacerbations.

6. Study concept Value Study Design Methods Findings Interpretation
Clinical and demographic characterisation of patients
Univariate analysis to identify individual baseline factors associated with risk of recurrent exacerbations in the outcome period
Multivariate analysis to identify composite groups of risk factors predictive of future risk
Develop an individualised risk scoring tool
Compare and contrast tool with UK clinical tools
Historical cohort study using population based clinical records from the BC Ministry of Health
3 year study period
Value
Findings
Independent predictors (demographic and clinical) associated with future attacks
Interpretation
Validation of the UK model in an administrative healthcare data system.

7. Suggested areas for research
Early detection of deterioration
Adherence
Education
Replacing annual reviews

8. Future interests with draft proposals
REG_P025: Identify and prioritise multi-stakeholder end-user needs for TBS in respiratory and allergic airway disease
REG_P026: Guidance to standardise the development of TBS with utility for respiratory and allergic airway diseases
REG_P028: Systematic review of behavioural change theory in the context of TBS for respiratory and allergic airways disease

9. Identify and prioritise multi-stakeholder end-user needs for TBS in respiratory and allergic airway disease (REG_P025)
Working title
Rationale
Optimizing the Delivery of Triple Therapy in the Real- World Management of Patients with Chronic Obstructive Pulmonary Disease.
Technology based solutions in respiratory medicine must be “needs-focussed” and address an end user’s need in order to ensure their engagement and persistence.
there is a need for consideration of specific subgroups as the needs of patients differ depending on their primary diagnosis and change depending on the current clinical scenario of the patient, their stage of disease and their age and attitude to technologies.
Objective
To develop a series of end user specific checklists to guide developers in their creation of meaningful and relevant respiratory technologies. 
Proposed methodology
Design: Parallel Delphi procedures to capture and prioritise different stakeholder specific needs
Population: Non-selective real-life COPD population
Exposures: Triple therapy compared to other treatment options
Outcomes: Exacerbations, adherence

10. Identify and prioritise multi-stakeholder end-user needs for TBS in respiratory and allergic airway disease (REG_P025)
Similar approach:

11. Systematic review of behavioural change theory in the context of TBS for respiratory and allergic airways disease (REG_P028)
Working title
Rationale
M-health solutions for self- management in respiratory health: what are their active ingredients and how are they delivered?
Long-term respiratory condition requires continuous self-management
Numerous m-health solutions have been developed to support self-management, however they are often developed with minimal input from communication or behavioral science and limited testing, with mixed success
Clinicians and health technology developers would benefit from clear guidelines for using these conceptual tools in developing m-health solutions
A first step in developing these recommendations is to assess the current state-of-the-art in m-health interventions in order to identify how behavior change support is delivered by available technology.
Objective
To examine published literature AND/OR available solutions from a communication and behavioral perspective to identify the content and format of the intervention delivered
To investigate the relationships between these characteristics and intervention success (defined in terms of user satisfaction, behavior change and health outcomes)
This may compliment the Novartis study well.
Proposed methodology
Design: Systematic review of existing literature with coding of communication and behavioural content and format
Inclusion criteria: peer reviewed articles describing m-health solutions, focusing on self-management and used in respiratory conditions

12. Future interests
Advertising/promoting the asthma risk tool on the REG website
Device optimisation for improved adherence and outcomes (Novartis study)
Phase 1 - Develop a standard setting piece by means of a Delphi exercise to identify and detail what all new types of technologies must do/gather in order to deliver relevant and necessary information. 
Phase 2 - Study design that could be used to test all new technologies/combination of technologies.  
Meta-analysis of existing data on effectiveness of SMART-inhalers
Link with Asthma UK
Varying the length between a patient’s asthma review based on risk profile
Using the work on asthma risk prediction, determine patient-specific review schedules, rather than an annual review
Varying length of review: Different types of intervention, based on risk profile. E.g. questionnaires for low risk.

13. Other research ideas?

14. Setting priorities Are these projects still:
Relevant?
Feasible?
Valid?
A priority?
How do we set priorities in technologies research?
How to we ensure these priorities are pursued?
Grant submissions? Commercial funding? How to bridge the gap from small start ups to large-scale studies
What are the two most important projects to push forwards?

15. Any other business?