Project Harvey

Thesis Proposal School of Design Carnegie Mellon University Academic Year 2018-2019

Improving post acute care experience for patients living with chronic heart conditions

Sponsored by Highmark

Suzanne Choi

Laura Rodriguez-Eng

MDes Candidate, 2019

MDes Candidate, 2019

suzanne1@andrew.cmu.edu

lhrodrig@andrew.cmu.edu

Kristin Hughes

Wayne Chung

Thesis Advisor

Thesis Advisor

kh@andrew.cmu.edu

wcchung@andrew.cmu.edu

Introduction

The application of design thinking within the healthcare field provides the potential to look at healthcare issues from a different perspective. For our thesis research, we will be exploring the relationship between chronic diseases, specifically chronic cardiovascular disease, and their post-acute care management.

“One third of patients with a chronic disease find it hard to understand their own condition and the advice they receive from their doctor or health visitor” (Friss, Karina, et al. 2016)

Readmission and

Chronic diseases are one of the leading factors contributing to the United States’ annual

Post-Acute Care

$2.7 trillion in healthcare costs, with cardiovascular disease contributing up to $190 billion in healthcare costs, which includes the cost of healthcare services, medications, and lost productivity. (Center for disease control and prevention, 2018) Many healthcare services contribute to these growing economic costs, including the increased rate of readmissions. Medicare spends approximately $528 million per year on readmissions of discharged patients. Factors, including abrupt transitions or poorly planned post-acute care strategies, have influenced these rising rates and associated costs. Currently, hospitals in the United States are experiencing an increased surgence of readmission rates by patients with chronic diseases. (Butala, Kramer et al. 2018) There are many factors that contribute to these growing readmission rates, one being the limited communication that occurs between healthcare providers (acute and postacute) and patients. Currently, few systems are fully integrated across inpatient and outpatient care and post-discharge settings. The lack of effective communication channels throughout the whole process, coupled with the lack of transparency within our current healthcare system and limited educational patient resources, makes it extremely difficult to coordinate care among medical stakeholders.

Friis, Karina, et al. "Gaps in Understanding Health and Engagement with Healthcare Providers across Common Long-Term Conditions: A Population Survey of Health Literacy in 29 473 Danish Citizens." BMJ Open 6.1 (2016).

Print.

Center for disease control and prevention, 2018. WEB. https://www.cdc.gov/chronicdisease/about/costs/ index.html Butala, Kramer et al. 2018CenApplicability of Publicly Reported Hospital Readmission Measures to Unreported Conditions and Other Patient Populations: A Cross- Sectional All-Payer Study.

Choi, Rodriguez-Eng | Thesis Proposal 1

Aging Population and

According to the US census population projections, the nation’s elderly population, ages

Cardiovascular Disease

65 and older, will double to 81 million by 2050. This growing population will bring about an increase in health related problems including increased cases of chronic diseases.

Our main focus will be on the management of chronic cardiovascular disease. While some conditions related to cardiovascular disease are a result of aging or genetics, many cardiovascular conditions can be prevented through lifestyle choices. This makes it a prime case study to explore how communication channels can facilitate chronic cardiovascular disease management through behavior and wellness management.

(Center for disease control and prevention, 2018)

Opportunity and Impact

Based on this preliminary research, we will explore the relationship of post-discharge, post-acute care, and ongoing disease management that occurs between healthcare providers and patients. To maximize safety and certainty, healthcare providers need insight and access to a patient’s self-care throughout the process–––which requires maximum communication between care settings. Working with Highmark Health, we will look at the way communication can play a role in increasing the success rates of postacute care strategies resulting in reduced readmission rates and an improved postacute care experience. We hypothesize that the outcome will increase patient comprehension of medical diagnosis treatment and discharge instructions, provide transparency among medical stakeholders, and support healthcare providers with feedback to assist with early intervention treatments.

Center for disease control and prevention, 2018. WEB. https://www.cdc.gov/heartdisease/about.html

Choi, Rodriguez-Eng | Thesis Proposal 2

Research Questions

How might we design a solution that helps patients with chronic cardiovascular conditions manage their own post-discharge care?

01. Increasing patient comprehension Exploring ways we can help patients better manage their own health by increasing patient comprehension on medical diagnosis treatment and discharge instruction.

02. Transparency in post-acute care Exploring ways we can help medical providers make informed decisions about ongoing treatments by increasing transparency of post-acute care progress.

03. Continuously improving post-acute care Exploring ways we can help medical providers coordinate better post-acute care experiences in the future by establishing feedback loops among medical stakeholders.

Goals

Our goal is to provide tools and resources for patients with chronic cardiovascular conditions to better understand and manage their post-acute care plans successfully.

This will also aid medical providers with information to make early evidence-based changes to post-acute care treatment plans.

During the process, we expect to learn patient behaviors in post-acute care situations as well as effective methods of improving communication quality to increase patient comprehension.

A successful project will require an understanding of the current medical workflow as well as the behaviors and needs of the target users (providers and patients). The success will be measured by the percentage of the at-risk population being reached, reduction in 30-day readmission rate, and improvement in the post-acute care patient experience.

Choi, Rodriguez-Eng | Thesis Proposal 3

Scope and limits

We plan to design a solution to provide appropriate support and tools for healthcare providers, patients, and community members for an improved post-acute care experience. We hypothesize that the outcome will increase patient comprehension of medical diagnosis treatment and discharge instructions, provide transparency among medical stakeholders, and support healthcare providers with feedback to assist with early intervention treatments.

We intend to showcase how the proposed solution will work with the general patient population dealing with chronic cardiovascular disease and suggest how it can apply to serve a broader audience. We do not intend to design and prototype for every use case in a hospital setting and every patient case.

Choi, Rodriguez-Eng | Thesis Proposal 4

Resources and feasibility

Successful completion of this project will require exposure to clinical context (hospitals, post-acute care facilities, patient’s home), understanding of discharge communication patterns, knowledge in design research, and recruiting participants (patients with chronic cardiovascular conditions, healthcare providers, and caregivers ).

Access to participants and clinical context: Collaboration with Highmark will provide access to participants and medical facilities that we need to conduct primary research including stakeholder interviews, contextual inquiry, participatory design, co-create workshops, and cultural probe.

Understanding discharge communication pattern and patient behavior in post-acute care situations: We hope to gain a solid understanding of clinical workflow, discharge patterns, and patient behaviors during post-acute care situations with primary and secondary research.

During the summer, we both worked on healthcare projects, where we completed preliminary research.

Suzanne Choi: UX Design Intern at Google AI: Healthcare Laura Rodriguez: Design Research Intern at 3M Design: Healthcare Business Group

Knowledge of design research: With our education and previous work experience, we are familiar with research methods and design thinking practices we want to investigate in exploratory, generative, prototyping, and evaluation phases outlined in the next section.

Technical and design skill: We had multiple experiences in designing for prints, screen, and physical applications.

We are also collaborating with two undergraduate communication and product design major students to enrich the project further. We plan to take physical computing and machine learning courses next semester to supplement our technical knowledge.

Choi, Rodriguez-Eng | Thesis Proposal 5

Approach, Methods

Exploratory Research

and Timeline

Interviews, Contextual Inquiry, Survey, Diary Study, Literature Reviews Competitive Analysis, Shadowing Generative Research Participatory Design (Co-design), Journey mapping, Storyboarding, Speed Dating Design Workshop, Desirability Testing Prototyping and Evaluation Experience Prototyping, Wireframing, User Testing, Visual Language High Fidelity Mockups, Interactive Prototyping

May-August, 2018

Establish partnership with Highmark Preliminary Research (summer internship)

September, 2018

Exploratory research (secondary) Exploratory research (primary)

October, 2018

Synthesize exploratory research Begin generative research

November, 2018

Generative research Concepting and prototyping (co-design sessions)

December, 2018

Evaluative research (mid-fi) Refine and synthesize (mid-fi) Poster session

January, 2019 Fabruary, 2019

Prototyping and evaluation (mid-fi) Refine prototypes (high-fi) Define visual language

March, 2019

Refine prototypes (high-fi) Interactive prototyping

April, 2019

Synthesize findings and document Write final thesis report

May, 2019

Final presentation Choi, Rodriguez-Eng | Thesis Proposal 6

Relevant Works

City health works http://cityhealthworks.com City health works provides health coaching and care coordination for patients with chronic disease.

City Block https://www.cityblock.com Cityblock provides personalized health service for qualifying Medicaid or Medicare members, and others living in city neighborhoods that face barriers to good health.

Sensely http://www.sensely.com Sensely is an AI chatbot system that helps clarifying patient’s medical questions and self-diagnosis process.

Catalia health http://www.cataliahealth.com Catalia health is a Interactive robot that helps elderly patients manage medication compliances and at-home care.

Patients like me https://www.patientslikeme.com Online community that allows patients to share and discuss symptoms and treatment plans in order to help patients understand their disease better and self identify areas of improvement AiCure https://aicure.com Using face recognition and gamification, Ai Cure helps patients with medication compliances.

MyUPMC https://myupmc.upmc.com Online platform that stores patient data and test result and provides patients a space to communicate with doctors.

Paper instruction handout upon discharge Summarizes hospital visit (symptoms and diagnosis) for patients and explains medications instruction.

Choi, Rodriguez-Eng | Thesis Proposal 7

Reading list

Books How Doctors Think, Houghton Mifflin Harcourt. Groopman, J. (2008).

Social Organization of Medical Work, Transaction Publishers. Strauss, A.L. and S. Y. Fagerhaugh (1997).

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age. Wachter, Robert (2015).

Better: A Surgeon's Notes on Performance. Gawande, Atul (2007).

Complications: A Surgeon's Notes on an Imperfect Science. Gawande, Atul (2002).

When Breath Becomes Air. Kalanithi, Paul (2016).

America's Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System. Brill, Steven (2015).

Journals and articles Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. (Cristina Boccut, Giselle Casillas 2017) Healthcare Provider-Patient Communication: A Satisfaction Study in the Outpatient Clinic at Hospital Kuala Lumpur: (Azizam and SHAMSUDDIN 2015) Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews(12). Dwamena, F., et al. (2012).

The measurement of patients' expectations for health care: a review and psychometric testing of a measure of patients' expectations.: (Bowling, Rowe et al. 2012) Patients' experiences of their healthcare in relation to their expectations and satisfaction: a population survey.: (Bowling, Rowe et al. 2013) Applicability of Publicly Reported Hospital Readmission Measures to Unreported Conditions and Other Patient Populations: A Cross- Sectional All-Payer Study.: (Butala, Kramer et al. 2018) Healthcare provider-patient communication: a satisfaction study in the outpatient clinic at Hospital Kuala Lumpur. The Malaysian journal of medical sciences: MJMS 22(3): 56.

Azizam, N. A. and K. SHAMSUDDIN (2015).

Choi, Rodriguez-Eng | Thesis Proposal 8

Reading list

Journals and articles (continue) Friis, Karina, et al. "Gaps in Understanding Health and Engagement with Healthcare Providers across Common Long-Term Conditions: A Population Survey of Health Literacy in 29 473 Danish Citizens." BMJ Open 6.1 (2016). Print.

Graham, Suzanne, and John Brookey. "Do Patients Understand?" The Permanente Journal 12.3 (2008): 67-69. Print.

Ha, Jennifer Fong, and Nancy Longnecker. "Doctor-Patient Communication: A Review."

The Ochsner Journal 10.1 (2010): 38-43. Print.

Dwamena, F., et al. "Interventions for Providers to Promote a Patient-Centred Approach in Clinical Consultations." Cochrane Database of Systematic Reviews.12 (2012). Print.

Contributing factors for readmission (article) https://www.besler.com/patients-at-high-risk-of-hospital-readmission/ What does it mean by health literacy and what affects it (article) https://health.gov/communication/literacy/quickguide/factsbasic.html Nearly half of patients do not understand medical language (article) https://www.telegraph.co.uk/news/health/news/10909421/Nearly-half-of-patientsdo-not-understand-medical-language.html Health Care Insider: How Do You Know Your Patients Understand You? (article) https://healthcare.utah.edu/the-scope/shows.php?shows=0_lpkqortq

Choi, Rodriguez-Eng | Thesis Proposal 9