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

Electronic Self-Report Assessment for Cancer and Self-Care Support: Results of a Multicenter Randomized Trial

PURPOSE: The purpose of this trial was to evaluate the effect of a Web-based, self-report assessment and educational intervention on symptom distress during cancer therapy. PATIENTS AND METHODS: A total of 752 ambulatory adult participants were randomly assigned to symptom/quality-of-life (SxQOL) screening at four time points (control) versus screening, targeted education, communication coaching, and the opportunity to track/graph SxQOL over time (intervention). A summary of the participant-reported data was delivered to clinicians at each time point in both groups. All participants used the assessment before a new therapeutic regimen, at 3 to 6 weeks and 6 to 8 weeks later, completing the final assessment at the end of therapy. Change in Symptom Distress Scale–15 (SDS-15) score from pretreatment to end of study was compared using analysis of covariance and regression analysis adjusting for selected variables. RESULTS: We detected a significant difference between study groups in mean SDS-15 score change from baseline to end of study: 1.27 (standard deviation [SD], 6.7) in the control group (higher distress) versus −0.04 (SD, 5.8) in the intervention group (lower distress). SDS-15 score was reduced by an estimated 1.21 (95% CI, 0.23 to 2.20; P = .02) in the intervention group. Baseline SDS-15 score (P < .001) and clinical service (P = .01) were predictive. Multivariable analyses suggested an interaction between age and study group (P = .06); in subset analysis, the benefit of intervention was strongest in those age > 50 years (P = .002). CONCLUSION: Web-based self-care support and communication coaching added to SxQOL screening reduced symptom distress in a multicenter sample of participants with various diagnoses during and after active cancer treatment. Participants age > 50 years, in particular, may have benefited from the intervention

Electronic self-report assessment for cancer and self-care support: Results of a multicenter randomized trial

The purpose of this trial was to evaluate the effect of a Web-based, self-report assessment and educational intervention on symptom distress during cancer therapy