title: Innovation by patients with rare diseases and chronic needs.
abstract: We provide the first empirical exploration of disease-related innovation by patients and their caregivers. Our aims were to explore to what degree do patients develop innovative solutions; how many of these are unique developments; and do these solutions have positive perceived impact on the patients' overall quality of life? In addition, we explored the factors associated with patient innovation development, and sharing of the solutions that the patients developed.
  
  
  METHODS
  We administered a questionnaire via telephone interviewing to a sample of 500 rare disease patients and caregivers. The solutions reported were pre-screened by the authors for their fit with the self-developed innovation aim of the study. All the reported solutions were then validated for their novelty by two medical professionals. Logistic regression models were used to test the relationships between our key variables, patient innovation and solution sharing.
  
  
  RESULTS
  263 (53%) of our survey respondents reported developing and using a solution to improve management of their diseases. An initial screening removed 81 (16%) solutions for being an obvious misfit to the self-developed innovation aim of the study. This lowered the sample of potentially innovative solutions to 182 (36%). Assessment of novelty and usefulness of the solutions, conducted by two medical evaluators, confirmed that 40 solutions (8%) were indeed novel, while the remaining 142 (28%) were already known to medicine. The likelihood of patient innovation increased as the education level increased (OR 2, p < 0.05), and as their perception of limitations imposed by their disease increased (OR 1.3, p < 0.05). 55 individuals diffused their solutions to some degree, with 50 of these sharing via direct diffusion to other patients. There is a positive relationship between the impact of a solution on the respondents' overall quality of life and likelihood of solution sharing.
  
  
  CONCLUSIONS
  Given that hundreds of millions of people worldwide are afflicted by rare diseases, patient and their caregivers can be a tremendous source of innovation for many who are similarly afflicted. Our findings suggest that many patients could be greatly assisted by improved diffusion of known solutions and best practices to and among patients and their caregivers.
authors.affiliation: UCP - Católica-Lisbon School of Business and Economics, Lisbon, Portugal. poliveira@ucp.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Oliveira
authors.affiliation: UCP - Católica-Lisbon School of Business and Economics, Lisbon, Portugal. leid.zejnilovic@cmu.edu.|Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, USA. leid.zejnilovic@cmu.edu.
authors.forename: Leid
authors.initials: L
authors.lastname: Zejnilovic
authors.affiliation: University of Lisbon School of Medicine and Santa Maria Hospital, Lisbon, Portugal. hcanhao@medicina.ulisboa.pt.
authors.forename: Helena
authors.initials: H
authors.lastname: Canhão
authors.affiliation: MIT Sloan School of Management, Cambridge, MA, USA. evhippel@mit.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: von Hippel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003405:Creativity; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D035583:Rare Diseases / Q000503:physiopathology* / Q000523:psychology; D055815:Young Adult