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Velocity-weighting & velocity-penalty MPC of an artificial pancreas: Improved safety & performance.

ABSTRACT: A novel Model Predictive Control (MPC) law for the closed-loop operation of an Artificial Pancreas (AP) to treat type 1 diabetes is proposed. The contribution of this paper is to simultaneously enhance both the safety and performance of an AP, by reducing the incidence of controller-induced hypoglycemia, and by promoting assertive hyperglycemia correction. This is achieved by integrating two MPC features separately introduced by the authors previously to independently improve the control performance with respect to these two coupled issues. Velocity-weighting MPC reduces the occurrence of controller-induced hypoglycemia. Velocity-penalty MPC yields more effective hyperglycemia correction. Benefits of the proposed MPC law over the MPC strategy deployed in the authors' previous clinical trial campaign are demonstrated via a comprehensive in-silico analysis. The proposed MPC law was deployed in four distinct US Food & Drug Administration approved clinical trial campaigns, the most extensive of which involved 29 subjects each spending three months in closed-loop. The paper includes implementation details, an explanation of the state-dependent cost functions required for velocity-weighting and penalties, a discussion of the resulting nonlinear optimization problem, a description of the four clinical trial campaigns, and control-related trial highlights.

SUBMITTER: Gondhalekar R

PROVIDER: S-EPMC6051553 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Velocity-weighting & velocity-penalty MPC of an artificial pancreas: Improved safety & performance.

Gondhalekar Ravi R Dassau Eyal E Doyle Francis J FJ

Automatica : the journal of IFAC, the International Federation of Automatic Control 20180320

A novel Model Predictive Control (MPC) law for the closed-loop operation of an Artificial Pancreas (AP) to treat type 1 diabetes is proposed. The contribution of this paper is to simultaneously enhance both the safety and performance of an AP, by reducing the incidence of controller-induced hypoglycemia, and by promoting assertive hyperglycemia correction. This is achieved by integrating two MPC features separately introduced by the authors previously to independently improve the control perform ...[more]

PMID: 30034017

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Project description:BackgroundThe Hospital Readmissions Reduction Program (HRRP), established by the Centers for Medicare and Medicaid Services (CMS) in March 2010, introduced payment-reduction penalties on acute care hospitals with higher-than-expected readmission rates for acute myocardial infarction (AMI), heart failure, and pneumonia. There is concern that hospitals serving large numbers of low-income and uninsured patients (safety-net hospitals) are at greater risk of higher readmissions and penalties, often due to factors that are likely outside the hospital's control. Using publicly reported data, we compared the readmissions performance and penalty experience among safety-net and non-safety-net hospitals.MethodsWe used nationwide hospital level data for 2009-2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. We identified as safety-net hospitals the top quartile of hospitals in terms of the proportion of patients receiving income-based public benefits. Using a quasi-experimental difference-in-differences approach based on the comparison of pre- vs. post-HRRP changes in (risk-adjusted) 30-day readmission rate in safety-net and non-safety-net hospitals, we estimated the change in readmissions rate associated with HRRP. We also compared the penalty frequency among safety-net and non-safety-net hospitals.ResultsOur study cohort included 1915 hospitals, of which 479 were safety-net hospitals. At baseline (2009), safety-net hospitals had a slightly higher readmission rate compared to non-safety net hospitals for all three conditions: AMI, 20.3% vs. 19.8% (p value< 0.001); heart failure, 25.2% vs. 24.2% (p-value< 0.001); pneumonia, 18.7% vs. 18.1% (p-value< 0.001). Beginning in 2012, readmission rates declined similarly in both hospital groups for all three cohorts. Based on difference-in-differences analysis, HRRP was associated with similar change in the readmissions rate in safety-net and non-safety-net hospitals for AMI and heart failure. For the pneumonia cohort, we found a larger reduction (0.23%; p < 0.001) in safety-net hospitals. The frequency of readmissions penalty was higher among safety-net hospitals. The proportion of hospitals penalized during all four post-HRRP years was 72% among safety-net and 59% among non-safety-net hospitals.ConclusionsOur results lend support to the concerns of disproportionately higher risk of performance-based penalty on safety-net hospitals.

Dataset Information

Velocity-weighting & velocity-penalty MPC of an artificial pancreas: Improved safety & performance.

Publications

Velocity-weighting & velocity-penalty MPC of an artificial pancreas: Improved safety & performance.

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