Causes For 30 day Hospital Readmissions
30-day hospital readmission rates have been increasing and there are now sanctions being placed on the hospitals for higher than average cases. This costs the hospitals almost 17 million dollars each year.
For patients, 175, 000 lives each year are lost due to medication errors resulting from discharges that were not effective in patient education and medication management.
A Discharge Instruction Sheet From The Hospital
Chronic and very serious conditions such as Congestive Heart Failure and Diabetes with complications are a leading cause of hospital admissions. readmission rates of those patients within thirty days of their discharge.
66% Readmission Rate
, 65% of those are due directly to some version of medication errors,
lack of follow through with medication reconciliation at times of transfer
Patient non adherence due to lack of understanding or education regarding the necessity of these medications.
Taking to few
Taking to many.
Forgetting to take them.
JCHAO has recommended for the last several years to incorporate pharmacies more into the care of these patients.
Several tests done in hospitals through out the country have been run and there is a marked difference in the outcomes of those patients that understand their medication regimen and are active participants and those that are left to their own defenses.
This project started as a small passion project trying to reach the shut-ins in San Francisco, that are served by Meals on Wheels. It has since spiraled into something larger and I'm glad to be part of it, especially since it was my first exposure to agile methodology.
Finding Our Validation
Quote from an email I received while doing validation for the project from a Dean of Cardiology at Duke University Nursing program.
Non-compliance is HUGE...a factor in loss of jobs, loss of quality of life, huge increase in cost ofhealthcare for all of us in rise of cost of insurance premiums, deductibles, and taxes to support medicaid and medicare. We tried educating the pt., but they are overwhelmed at lifestyle changes, including taking meds...and there is no follow up. Noncompliance is such a complex issue, YES, we need to involve pharmacists, social workers, psychologists, nurses, educators. ... push for this change in attitude and policy. .Non-compliance doesn't just affect patients, but families and communities
.~Evelyn Reeves, M.ed. RN
Analyze Our Data & Instill Empathy
As the little project took on a life of its own, it attracted the help of some very experienced members of the UX/design community as well as the academic behavioral psychology field.
One Saturday morning, myself, a behavioral research psychologist and adjunct professor from USF, a two-time medical start-up entrepreneur, a HCI graduate student and a talented motion graphics artist from Lucas Films, Ltd. put our heads together to figure out what direction to take this in..
We began working on the persona coming up with two. One of an elderly lady, She is in her eighties and suffering from diabetes,
We employed the value proposition and thinking , feeling doing methods to discover our pain points and barriers to medication adherence during two three-hour long sprints.
Stopping Scope Creep
Once we had that down, I designed the site map and flow for the application. It became very in-depth, so we as a team decided to focus on one area and that was the onboarding of a new patient into the program. We would tackle the large genre that this issue encompasses and focus on the onboarding of the patient into a new medication behavioral modification system. With this portion of a larger application, the person diagnosed and discharged is given the choice of how to receive medication reminders, using behavior modification incentives such as hearing a recorded message from their grandchildren. It also allows the primary care physicians' staff to monitor the patterns of the newly discharged and to triage their follow-up visits according to compliance with the alert /reminder/check-in application. If a person does notrespond that they have taken the medication by clicking the button on the phone, the MD is alerted as well as closest kin if there is one.
The more focused approach is found below :
HOW TO MAKE THINGS FRIENDLY , APPROACHABLE AND LOW BARRIER TO USE
The approach to the medication onboarding took on the format of low entry interface. Taking into account the person's lifestyle when setting up reminders we went for a very simplistic wording and opted for having them only have to type into an input twice, the rest is done through just pressing one or two buttons. Keeping in mind the physical abilities we made the buttons especially broad so that someone with arthritis or another type of disability would not find it difficult. Onboarding questionnaire was inspired by the Eden Alternative.
Click the orange on-boarding questionnaire link to experience the initial take on behavioral driven medication adherence
We went for a skeuomorphic look due to the age range of the target user. To make things much more understandable. We also incorporated a text to speech barcode scanner to aid those that have visual impairment . With this they can scan the bottle and it will announce what medication is inside and what the directions are. They an verify the right pills and confirm them by hitting the large green button. In our validation research, we found one of the biggest fears and barriers people had was the loss of power and control over their own lives. We try to give some of that back to them through these methods.
INTERACTIVE PROTOTYPE USED FOR USABILITY TESTING
GO AHEAD AND PLAY WITH IT! YOU KNOW YOU WANT TO!
This project touches a special place with me, having lost my husband due to medication errors that the end product hopes to solve. The need for a streamlined approach to medication management and the post inpatient follow up is starting to be realized which gives me hope. The problem we face with implementing this is in the convoluted maze like structuring of institutionalized historical ways of doing things, and the almost "my fish is bigger than yours" mentality that invades the different areas of healthcare".
I learned that its better to focus on just one aspect of a large problem first, to really get into the why's of that area and to flush the value proposition and pain points out, instead of trying to tackle something huge right off the bat. So I take away the experience of agile, the quick turnaround and iterations which speak to my love of the adrenaline rush I used to only feel when having to work and think on my feet in the emergency department, as a way of doing UX that I can embrace.
I also take away the experience of working with people that have many more years of experience in this field and the knowledge I was able to suck from them , the knowledge they generously gave to me is invaluable. At the moment , this project is still in development, and the following project, Angel Guard which is part of the whole umbrella product is in a research phase with backing having gone into the design of the tracking chip and the two should see the light on the market in the upcoming summer months of 2016.
Visual Design/ UI: Sonja Green , Erika Harvey
Business Design: Gil McRae
Product Owner Andrea Wu
User research, data analysis and Ux design: Michael Cohn PHd, Erika Harvey
Technologies and skills used: Journey Mapping, Process Flows, Gorilla Usability Testing , Validation Interviews, Agile Sprints,AxureRp, Adobe Illustrator, Marvel.io, paper and pen and our favorite: The post it note.