Authors: Asim H. Gazi, Daiqi Gao, Susobhan Ghosh, Ziping Xu, Anna Trella, Predrag Klasnja, Susan A. Murphy
Abstract
Just-in-time adaptive interventions (JITAIs) are nascent precision medicine systems that extend personalized healthcare support to everyday life. A challenge in designing JITAIs is that personalized support often involves sophisticated decision-making algorithms. These decision-making algorithms can require numerous non-trivial design decisions that must be made between successive JITAI deployments (e.g., hyperparameter selection for an artificial intelligence algorithm). Making design decisions between deployments–rather than during deployment–ensures intervention fidelity and enhances the ability to replicate results. Yet, each deployment can be costly, precluding the use of A/B testing for every design decision. How should design decisions be made strategically between JITAI deployments? This paper introduces digital twins for just-in-time adaptive interventions (JITAI-Twins) to address this question. JITAI-Twins are “digital twins of a subpopulation” (term from National Academies workshop proceedings [1]). JITAI-Twins are used to virtually simulate the potential outcomes of a JITAI’s design decisions for an upcoming deployment. Based on simulation results, design decisions are made for the deployed JITAI. To continually improve the JITAI, data collected during deployment is used to update the JITAI-Twin – and this bidirectional feedback between deployments and simulation environments continues. JITAI-Twins are thus “fit-for-purpose” (term from National Academies consensus report [2]) instantiations of the digital twin concept. In this paper, we elucidate the specifics and design process of JITAI-Twins, with examples of prior use in clinical settings. JITAI-Twins highlight continuity over the course of a JITAI’s optimization and continual improvement, emphasizing the need for bidirectional feedback between versions of a simulation environment and a JITAI’s deployments.
Access on JMIR Preprints: 10.2196/preprints.72830