Using the Analytic Hierarchy Process (AHP) to understand the most important factors to design and evaluate a telehealth system for Parkinson's disease

Abstract

BackgroundThe assessment of a new health technology is a multidisciplinary and multidimensional process, which requires a complex analysis and the convergence of different stakeholders into a common decision. This task is even more delicate when the assessment is carried out in early stage of development processes, when the maturity of the technology prevents conducting a large scale trials to evaluate the cost effectiveness through classic health economics methods. This lack of information may limit the future development and deployment in the clinical practice. This work aims to 1) identify the most relevant user needs of a new medical technology for managing and monitoring Parkinson's Disease (PD) patients and to 2) use these user needs for a preliminary assessment of a specific system called PERFORM, as a case study.MethodsAnalytic Hierarchy Process (AHP) was used to design a hierarchy of 17 needs, grouped into 5 categories. A total of 16 experts, 6 of them with a clinical background and the remaining 10 with a technical background, were asked to rank these needs and categories.ResultsOn/Off fluctuations detection, Increase wearability acceptance, and Increase self-management support have been identified as the most relevant user needs. No significant differences were found between the clinician and technical groups. These results have been used to evaluate the PERFORM system and to identify future areas of improvement.ConclusionsFirst of all, the AHP contributed to the elaboration of a unified hierarchy, integrating the needs of a variety of stakeholders, promoting the discussion and the agreement into a common framework of evaluation. Moreover, the AHP effectively supported the user need elicitation as well as the assignment of different weights and priorities to each need and, consequently, it helped to define a framework for the assessment of telehealth systems for PD management and monitoring. This framework can be used to support the decision-making process for the adoption of new technologies in PD.

A holistic approach to assess the feasability of telehealth for Parkinson's disease management

“…The result of AHP conform a framework that can be used lately for the evaluation of different systems. Basically, thanks to this tool it is possible to identify which aspect should be maximized in order to actually improve the health outcomes [20], [588].…”

“…Accordingly, it may limit future development iterations and the actual deployment in the clinical practice. Part of this chapter has been published on Cancela et al 2015 "Using the Analytic Hierarchy Process (AHP) to understand the most important factors to design and evaluate a telehealth system for Parkinson's disease" on the Journal BMC medical informatics and decision making [567] as well as in the proceedings of a few international conferences [18], [19].…”

“…30 Can only carry out very few tasks without help; patient now highly dependent on other people. 20 Unable to carry out any tasks alone; severely disabled; patient now nearly completely dependent on other people. 10 Unable to carry out any tasks; completely disabled.…”

“…A specific protocol was designed to collect motor data (patients were asked to carry out activities of daily life such as walking, sitting or lying on a bed in the hospital facilities), as well as non-motor symptoms (cognitive tests were implemented in Android environment to collect data), speech signals were also collected using the smartphone microphone. First works reported user needs analysis [20] and a preeliminary assessment of motor [490] and non-motor symptoms [491]. …”

“…In the third step of the evaluation process the patients were asked to provide a rating from 0 to 10 representing their own feeling of pain/discomfort for each body part (Borg CR-10 scale for pain/discomfort). Finally, in the last section of the evaluation the patients were asked to read a number of statements and to provide a rating between Low (0) and High (20) corresponding to their level of agreement with each statement. The patients' responses are indicated in the following sections.…”