Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Improving Adolescent Asthma Management Using a Smart Phone Application

Asthma is a common condition in adolescence and finding a way to optimize asthma care management is a priority in primary care. The purpose of this project was to introduce an electronic asthma action plan using a smartphone application to help adolescents improve asthma control, medication adherence, self-efficacy, and overall quality of life. This quality improvement project compared asthma control testing scores between traditional paper-based asthma action plans and the smartphone application. The setting was a pediatric private practice and the sample goal was twenty or more participants who presented to the clinic for well adolescent or back to school sports physical visits. The evidence-based practice intervention was to implement the change from paper-based asthma action plans to a new smartphone application for all patients with asthma seen in clinic. The Asthma Control Test was the tool used to measure improved asthma control outcomes by using the application. A 13.2% average increase in asthma control test scores post- intervention was achieved in this project. The world is moving to a technology focused and mobile health application centered plan, and the use of an asthma action plan could positively impact adolescent and other population asthma control, reduce healthcare costs, reduce missed school and work and improve quality of life

An eHealth Framework for Managing Pediatric Growth Disorders and Growth Hormone Therapy

Background: The use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder. Objective: Our objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy. Methods: A total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy. Results: A total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed. Conclusions: The use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway.Peer reviewe

Doctor of Philosophy

dissertationOne out of every six children in sub-Saharan Africa dies from treatable diseases before reaching age 5. Millions of these deaths could be averted if health care providers followed evidence-based protocols, such as the Integrated Management of Childhood Illnesses (IMCI), to provide care. IMCI assists providers to diagnose and treat problems for children under 5, and specifies key information for the provider to teach to the child's caretaker. While IMCI has been adopted as official policy throughout Tanzania, the protocol has been neither universally used nor consistently followed. An innovative IMCI-based protocol that runs on a mobile phone, called eIMCI, was designed for this study using user-centered design (UCD) principles to assist provider navigation of the protocol and improve provider-caretaker communication of key information points, including the problem and treatment of the child, and when to return to the clinic. The electronic protocol, eIMCI, was compared to an equivalent paper-based protocol, pIMCI. This study was based on the mHealth Communications Theoretical Framework. The aims of the study were to (1) utilize UCD design principles to develop eIMCI and evaluate its usability, and (2) evaluate the effect of protocol delivery platform on (a) provider communication and (b) caretaker recall of key information points. A randomized cluster trial was conducted in which health care clinics in Tanzania were randomized to implement each platform. Results suggested that electronic protocol use led to improved provider-caretaker communication. Providers who used eIMCI were more likely to give counseling that covered the key information points specified, and caretakers in the eIMCI arm recalled more of these key information points overall. The implications of this work suggested that the eIMCI mobile protocol may lead to improved provider-caretaker communication, which may result in a greater ability for caretakers to carry out treatment plans in the home. When utilizing mobile devices to deliver such interventions, the structure, clarity, and direction enabled by the electronic platform are suggested to promote adoption of the complete sphere of high-quality clinical care. As such adoption is continued, understanding of key health information may become firmly rooted in caretaker health literacy levels

Investing in The Health and Well-Being of Young Adults

This report was prepared to assist federal, state, and local policy makers and program leaders, as well as employers, nonprofit organizations, and other community partners, in developing and enhancing policies and programs to improve young adults' health, safety, and well-being. The report also suggests priorities for research to inform policy and programs for young adults.Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large

Track E Implementation Science, Health Systems and Economics

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138412/1/jia218443.pd

Baystate Medical Practices Annual Report - 2020

Baystate Medical Practices Annual Report - 2020https://scholarlycommons.libraryinfo.bhs.org/bmpannual_report/1005/thumbnail.jp