A Clinical Investigation of an Autonomous Phone Conversational Agent for Cataract Surgery Follow-up
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Plymouth
- Enrollment
- 225
- Locations
- 2
- Primary Endpoint
- Agreement
Study Overview
Brief Summary
This project will apply AI technology to meet the gap between increasing demand and limited capacity of high- volume healthcare services. The project will develop evidence that will support the safe deployment of Ufonia's automated telemedicine platform to deliver calls to cataract surgery patients at two large NHS hospital trusts.
The proposed study will implement DORA in addition to the current standard of care for a cohort of patients at Imperial College Healthcare Trust and Oxford University Hospitals NHS Foundation Trust. The study will evaluate the agreement of DORA's decision with an expert clinician. In addition it will test the acceptability of the solution for patients and clinicians; the sensitivity and specificity of the system in deciding if a patient requires additional review; and the health economic benefits of the solution to patients (reduced time and travel) and the local healthcare system. If successful, a proposal will be developed to roll the solution out to all patients at each site in anticipation of an application to a late phase award for wider NHS deployment.
Detailed Description
Background
Due to an ageing population and increased expectation, the demand for many services is exceeding the capacity of the clinical workforce. As a result, staff are facing a crisis of burnout from being pressured to deliver high- volume workloads, driving increasing costs for providers. Artificial intelligence, in the form of conversational agents, presents a possible opportunity to enable efficiencies in the delivery of care.
Aims and Objectives
This study aims to evaluate the effectiveness, usability and acceptability of DORA - an AI-enabled autonomous telemedicine call - for detection of post-operative cataract surgery patients who require further assessment. The study's objectives are: to establish efficacy of DORA's decision making in comparison to an expert human clinician; baseline sensitivity and specificity for detection of true complications; evaluation of patient acceptability; evidence for cost-effectiveness; and to capture data that may support further studies.
Project plan and methods used
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Screening
- Masking
- None
Masking Description
No masking is possible, because all participants receive the same intervention.
Eligibility Criteria
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Willing and able to provide informed consent;
- •Aged 18 years or older;
- •On the waiting list for routine cataract surgery. Cataract surgery as part of a combined procedure with other ocular surgery will not be included;
- •No history or presence of significant ocular comorbidities that would be expected to alter the risks of cataract surgery or normal post-operative follow-up schedule. Note that significant ocular comorbidities do not include stable, chronic, or inactive ocular conditions such as amblyopia, drop-controlled stable glaucoma or ocular hypertension, previous squint surgery, inactive macular pathology, previous refractive surgery, or previous vitreoretinal surgery with stable retina.
Exclusion Criteria
- •Individuals with any condition that could preclude the ability to comply with the study or follow-up procedures;
- •Presence of ocular or systemic uncontrolled disease (unless deemed not clinically significant by the Investigator and Sponsor);
- •Involved in current research related to this technology or been involved in related research to this technology prior to recruitment;
- •Cognitive difficulties, hearing impairment or non-English speakers;
- •History of current or severe, unstable or uncontrolled systemic disease (unless deemed not clinically significant by the Investigator and Sponsor).
Arms & Interventions
Dora follow-up phone call
DORA uses a variety of AI technologies to deliver the patient follow-up call, including: speech transcription, natural language understanding, a machine-learning conversation model to enable contextual conversations, and speech generation. Together, these technologies cover the input, processing and analysis, and output needed to maintain a natural conversation. DORA is configured to deliver calls through a telephone connection as a real-time, stand-alone system: the operator inputs individual patient details to initiate the call and completes a summary in the electronic health record (EHR) afterwards. The entire conversation will be supervised by a clinician. This clinician will be able to interrupt the call at any point if the system fails, the patient struggles to interact with it, or DORA does not collect sufficient information from the patient. The clinician will record a clinical assessment which will be compared to the DORA assessment.
Intervention: Dora (Other)
Outcomes
Primary Outcomes
Agreement
Time Frame: Inter-rater reliability was assessed based on data collected during Dora calls, which lasted an average of 7.5 minutes
Inter-rater reliability: the degree of agreement between DORA and the clinician on their assessments of the individual symptoms and the management plan; Whether or not the clinician had to interrupt the call to ask clarifying questions
Secondary Outcomes
- Clinical Complications Identified or Missed by DORA System(Up to 90 days post surgery)
- Calls Completed Without Intervention(Dora calls lasted an average of 7.5 minutes)
- System Usability(Usability assessments were completed up to 6 months after the Dora call)
- Usability of Telehealth System Implementation(Usability was assessed up to 6 months after the call)
- Qualitative Patient Perspectives of Usability(Semi-structured interview call, lasting up to 30 minutes, conducted up to 6 months after the Dora call)
- Acceptability of AI Follow-up Phone Call(Semi-structured interview call, lasting up to 30 minutes, conducted up to 6 months after the Dora call)
- Satisfaction With AI Follow-up Phone Call(Semi-structured interview call, lasting up to 30 minutes, conducted up to 6 months after the Dora call)
- Appropriateness of AI for Follow-up Assessment(Semi-structured interview call, lasting up to 30 minutes, conducted up to 6 months after the Dora call)
- Cost Impact(Conducted 6 months after baseline)
- Subsequent Unplanned Follow-up(Up to 90 days post surgery)
Investigators
Edward Meinert, PhD
Evaluation Lead
University of Plymouth