An exploratory study of an intranet dashboard in a multi-state healthcare system

Introduction: Management of complex systems is facilitated through effective information systems that provide real-time data to decision makers. For example, instrument panels in airplanes ensure that pilots have well-designed feedback concerning the status of mission-critical variables. Problem: While pilots have dashboards for feedback and communication, healthcare executives may be unaware of effective use of evidence-based guidelines within their healthcare system. Purpose: The first objective of this research was to design and implement an automated intranet dashboard reporting performance measures for a geographically dispersed health system. The second objective was to describe how this dashboard might increase cooperation and coordination for individuals and organizations involved with healthcare delivery. Design: This research was exploratory in nature, employing descriptive research approaches. A convenience sample of healthcare executives completed a baseline survey at the start of the study assessing levels of communication and cooperation. After three months of exposure to the dashboard, participants were asked to complete a follow-up survey. All visits to the dashboard were recorded in a web server log file. Semistructured qualitative exit interviews were also conducted to explore reactions to the dashboard, experiences with receiving outcome reports, and barriers to communicating and coordinating with counterparts. Results: Descriptive analysis of paired survey scores found substantial increases on a number of survey items, suggesting that the dashboard contributes toward increased communication and coordination for healthcare executives. This finding is balanced by the limited rigor in the research design and an analysis of the web server log file, which found few visitations to the dashboard by research participants. Qualitative data analysis suggests that current reporting mechanisms are suboptimal for healthcare executives and that one solution is the use of dashboards. Conclusion: This study resulted in a number of important discoveries and avenues for further research. A more rigorous research design is needed to explore the role of intranet dashboards in healthcare settings

Redesigning pictographs for patients with low health literacy and establishing preliminary steps for delivery via smart phones.

BackgroundPictographs (or pictograms) have been widely utilized to convey medication related messages and to address nonadherence among patients with low health literacy. Yet, patients do not always interpret the intended messages on commonly used pictographs correctly and there are questions how they may be delivered on mobile devices.ObjectiveOur objectives are to refine a set of pictographs to use as medication reminders and to establish preliminary steps for delivery via smart phones.MethodsCard sorting was used to identify existing pictographs that focus group members found "not easy" to understand. Participants then explored improvements to these pictographs while iterations were sketched in real-time by a graphic artist. Feedback was also solicited on how selected pictographs might be delivered via smart phones in a sequential reminder message. The study was conducted at a community learning center that provides literacy services to underserved populations in Seattle, WA. Participants aged 18 years and older who met the criteria for low health literacy using S-TOFHLA were recruited.ResultsAmong the 45 participants screened for health literacy, 29 were eligible and consented to participate. Across four focus group sessions, participants examined 91 commonly used pictographs, 20 of these were ultimately refined to improve comprehensibility using participatory design approaches. All participants in the fifth focus group owned and used cell phones and provided feedback on preferred sequencing of pictographs to represent medication messages.ConclusionLow literacy adults found a substantial number of common medication label pictographs difficult to understand. Participative design processes helped generate new pictographs, as well as feedback on the sequencing of messages on cell phones, that may be evaluated in future research

The electronic self report assessment and intervention for cancer: promoting patient verbal reporting of symptom and quality of life issues in a randomized controlled trial

Background: The electronic self report assessment - cancer (ESRA-C), has been shown to reduce symptom distress during cancer therapy The purpose of this analysis was to evaluate aspects of how the ESRA-C intervention may have resulted in lower symptom distress (SD). Methods: Patients at two cancer centers were randomized to ESRA-C assessment only (control) or the Web-based ESRA-C intervention delivered to patients’ homes or to a tablet in clinic. The intervention allowed patients to self-monitor symptom and quality of life (SxQOL) between visits, receive self-care education and coaching to report SxQOL to clinicians. Summaries of assessments were delivered to clinicians in both groups. Audio-recordings of clinic visits made 6 weeks after treatment initiation were coded for discussions of 26 SxQOL issues, focusing on patients’/caregivers’ coached verbal reports of SxQOL severity, pattern, alleviating/aggravating factors and requests for help. Among issues identified as problematic, two measures were defined for each patient: the percent SxQOL reported that included a coached statement, and an index of verbalized coached statements per SxQOL. The Wilcoxon rank test was used to compare measures between groups. Clinician responses to problematic SxQOL were compared. A mediation analysis was conducted, exploring the effect of verbal reports on SD outcomes. Results: 517 (256 intervention) clinic visits were audio-recorded. General discussion of problematic SxQOL was similar in both groups. Control group patients reported a median 75% of problematic SxQOL using any specific coached statement compared to a median 85% in the intervention group (p = .0009). The median report index of coached statements was 0.25 for the control group and 0.31 for the intervention group (p = 0.008). Fatigue, pain and physical function issues were reported significantly more often in the intervention group (all p < .05). Clinicians' verbalized responses did not differ between groups. Patients' verbal reports did not mediate final SD outcomes (p = .41). Conclusions: Adding electronically-delivered, self-care instructions and communication coaching to ESRA-C promoted specific patient descriptions of problematic SxQOL issues compared with ESRA-C assessment alone. However, clinician verbal responses were no different and subsequent symptom distress group differences were not mediated by the patients' reports. Trial registration NCT00852852; 26 Feb 200

Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD

Huong Q Nguyen1, Dawn P Gill1, Seth Wolpin1, Bonnie&amp;nbsp;G Steele2, Joshua O Benditt11University of Washington, seattle, WA, USA; 2VA Puget Sound Health Care System, Seattle, WA, USAObjective: To determine the feasibility and efficacy of a six-month, cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease (COPD) following pulmonary rehabilitation.Methods: Participants who completed a two-week run-in were randomly assigned to either MOBILE-Coached (n = 9) or MOBILE-Self-Monitored (n = 8). All participants met with a nurse to develop an individualized exercise plan, were issued a pedometer and exercise booklet, and instructed to continue to log their daily exercise and symptoms. MOBILE-Coached also received weekly reinforcement text messages on their cell phones; reports of worsening symptoms were automatically flagged for follow-up. Usability and satisfaction were assessed. Participants completed incremental cycle and six minute walk (6MW) tests, wore an activity monitor for 14 days, and reported their health-related quality of life (HRQL) at baseline, three, and six months.Results: The sample had a mean age of 68 &amp;plusmn; 11 and forced expiratory volume in one second (FEV1) of 40 &amp;plusmn; 18% predicted. Participants reported that logging their exercise and symptoms was easy and that keeping track of their exercise helped them remain active. There were no differences between groups over time in maximal workload, 6MW distance, or HRQL (p &amp;gt; 0.05); however, MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months (p = 0.04).Conclusions: We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring. The latter finding needs to be interpreted with caution since this was a purely exploratory study.Trial registration: ClinicalTrials.gov (NCT00373932).Keywords: chronic obstructive pulmonary disease, physical activity, exercise persistence, pulmonary rehabilitation, cell phone

Evaluation of online training on the prevention of venous thromboembolism.

IntroductionThe integration of new evidence into clinical practice can be a prolonged process, with delays of years or even decades. One approach to speed this integration is through the use of online provider education.ProblemVenous thromboembolism (VTE) is a serious patient safety issue. Prevention requires coordinated care and adherence to evidence-based guidelines, supported by provider education.PurposeThis study reports how an interdisciplinary team developed and piloted an online provider training program for the prevention of VTE.HypothesisIf providers use the online educational training, they will demonstrate increased mastery of key content areas related to VTE prophylaxis.MethodsWe used a prospective test-retest study design in which medical residents and fellows served as their own controls. All participants were given a pretest followed by educational content and then a posttest. We also assessed 2 different types of learning content (ie, with and without case studies/questions) and randomized participants to each type prior to assessment.ResultsUsing the McNemar test we found a trend for knowledge gains related to VTE guidelines on the posttest for clinicians (n = 67) with a 14.5% improvement in content mastery (P = .05, 2-tailed). We did not find any significant differences between training modalities. Clinicians overall reported high levels of satisfaction with the application.ConclusionOur online education efforts indicate the potential for increasing mastery of VTE prophylaxis concepts. If resources are limited, we suggest a static approach to content delivery and an exploration of standardized methods for portability of online curriculums across learning management systems