Exploring the potential for collaborative use of an app-based platform for n-of-1 trials among healthcare professionals that treat patients with insomnia

Abstract

Background: N-of-1 trials are single patient, multiple crossover, comparative effectiveness experiments. Despite their rating as level 1 evidence, they are not routinely used in clinical medicine to evaluate the effectiveness of treatments. Objective: We explored the potential for implementing a mobile app-based n-of-1 trial platform for collaborative use by clinicians and patients to support data-driven decisions around the treatment of insomnia. Methods: A survey assessing awareness and utilization of n-of-1 trials was administered to healthcare professionals that frequently treat patients with insomnia at the Icahn School of Medicine at Mount Sinai in New York City. 1M electronic health records were analyzed to evaluate evidence for a comorbid relationship between insomnia and dementia or Alzheimers disease among a patient population that may benefit from n-of-1 trials for the selection of optimal sleep treatments. Results: A total of 45 healthcare professionals completed the survey and were included in the analysis. We found that 64% of healthcare professionals surveyed had not heard of n-of-1 trials. After a brief description of these methods, 75% of healthcare professionals reported that they are likely or highly likely to use an app-based n-of-1 trial at least once in the next year if the service were free and easy to offer to their patients. Conclusions: An app-based n-of-1 trials platform might be a valuable tool for clinicians and patients to identify the best treatments for insomnia. Educational interventions that raise awareness and provide training are also likely necessary. The electronic health record (EHR) may help identify eligible patients.