Summary
Spotlight-AQ sets out to transform diabetes healthcare delivery, replacing ineffective, inefficient appointments with routine visits that focus on physical, mental and social well-being. Deliverable by any healthcare professional (HCP), in any setting, with any person with diabetes (PWD), Spotlight-AQ is designed to fit seamlessly within existing workflows and is time- and cost-saving. It results in significantly improved glycaemia and quality of life for PWD and increased efficiency and reduced burnout for HCPs. It sends a short, holistic questionnaire to each patient before a routine visit, with immediate results mapped to evidence-based resources supported by HCP discussion.
Innovation
Spotlight-AQ is a cloud-based clinical tool that addresses physical, mental and social aspects of diabetes management in every visit. It sends a brief, pre-clinic questionnaire to each patient up to a week before a routine visit. The AI algorithm adapts to each individual, identifying patient-identified concerns across psychological burden, social environment, therapy and skills gaps. It presents this complex information immediately in an easy-to-understand format for discussion at the visit. This tool identifies behavioural influencers and drivers that aid or obstruct self-management and maps safe, evidence-based resources to each identified need. This personalised approach enables HCPs to better understand patients’ individual needs. Spotlight-AQ has been proven to reduce visit length, reduce HCP burnout, streamline workflows and save money. It is available for adults with type 1 diabetes, type 2 diabetes or obesity, children with diabetes and their parents/caregivers.
Equality, Diversity and Variation
Spotlight-AQ provides every PWD the same opportunity for their voice to be heard. Presenting all users with questions that are relevant to their own lived experience, from a database of hundreds of questions, gives a clearer understanding of how different areas of a person’s life impact their diabetes management and vice versa. Each question has a mechanism of action to improve physical or mental health outcomes, so all priority concerns identified through the questionnaire (and other linked data, where desired) are insightful, personalised and action-focused. Spotlight-AQ has been validated in participants with different socioeconomic status. It was co-designed with hundreds of people with diabetes, from different communities and backgrounds. Charities, community and advocacy groups have also been consulted. Validated UK English, US English and LATAM Spanish versions are available and the team is working with South Asian communities in the UK to add tailored resources for them. An independent review by the Organisation for the Review of Health and Care Apps (ORCHA) achieved a score of 84%. The company is working with partners in Argentina, Chile and Colombia to transform care for underserved populations with diabetes. A multi-country randomised clinical trial (RCT) is being conducted using Spotlight-AQ in and between visits to prevent deterioration of glycaemic control and exacerbation of diabetes distress. Combining continuous glucose monitoring devices, if participants are <20% missing glucose data or <50% with a glucose time in target range, they automatically receive a new link to the Spotlight-AQ questionnaire and mapped resources according to their unmet need. This enables the delivery of routine care to include support for education and psychological well-being alongside glycaemic control.
Results
Spotlight-AQ was co-designed with PWD and HCPs, using focus groups, one-to-one interviews, surveys and feedback through pilot studies, feasibility studies, real-world evaluations and multi-centre RCTs. The team also engaged with the allied health science network and health innovation centres to ensure streamline workflow integration for health systems. Health Innovation Manchester, Leicestershire health system and Wessex are collaborating here. In one study mean HbA1c improvement was 15mmol/mol (1.4%), psychosocial outcomes improved, work-related QoL for HCPs improved and visit duration for intervention participants was shorter by 0.5-6.1mins (3-14%) versus no change in the control group (-0.9 - +1.28 mins). HCPs reported improved communication and greater focus on patient priorities in consultations. Cost-effectiveness analyses found the intervention to dominate usual care and have 68% probability of being cost-effective (threshold value: £30,000 per QALY gained). Artificial Intelligence examination highlighted therapy and psychological burden were most important in predicting HbA1c levels. Natural Language Processing semantic analysis confirmed the mapping relationship between questions and their corresponding concerns. The machine learning model revealed that type 1 and type 2 patients had different concerns regarding psychological burden and knowledge. It also emphasised that individuals with varying levels of HbA1c exhibited diverse levels of psychological burden and therapy-related concerns. A three-centre feasibility study was conducted in primary and specialist care settings in the UK and US to determine acceptability and usability. Results were positive.
User Feedback
Data showed that Spotlight-AQ was acceptable, relevant and tailored to individual needs, and that it could be implemented in clinical practices. Positive themes were ease of use, relevance, personalised feedback and simplicity of the tool. The wording of some questions was updated to aid clarity and remove ambiguity. The second phase analyses focused on acceptability for people with diabetes, as well as usefulness and relevance within routine clinical care for healthcare professionals. One-to-one interviews were conducted with 12 PWD and eight HCPs. All participants expressed enthusiasm for the tool and reported that it accurately identified personal priorities and clear appropriate care pathways to meet those needs. All HCPs stated that it would be useful in clinic to reduce consultation times and improve communication, as well as aiding greater understanding of patient needs.
Dissemination and Sustainability
Spotlight-AQ fits into routine care for every PWD (complete at home or in waiting room), with every HCP, in every visit. It has been used across primary and secondary care, with ongoing research with underserved populations. At an annual licence fee of £5,000 per centre (2,500 patients with diabetes or obesity), Spotlight-AQ is cost-effective. There are also cost savings through shorter visits. Key elements include improved communication, better understanding of patients’ unmet needs and reduced burnout for HCPs. Spotlight-AQ has multiple modes of communication, including written, oral and visual. Spotlight-AQ’s underpinning theory and structural framework can be applied to other health conditions and it has been used in COPD. The company has worked with PWD, charities and advocacy groups to disseminate results to the diabetes community.
