Summer and Fall '19

Kyuntae Kim, Tanvi Ranka, Xuning Guo

COMET: COPD Medication Education Tool

Summer and Fall project at Institute of Healthcare Delivery Design and UI health with the Respiratory Health Association (RHA). This project is about creating an in-patient medication education and symptom recognition tool for COPD (Chronic Obstructive Pulmonary Disorder) patients for better hospital-to-home transition. The discussion guide empowers the patient to recognise and manage their symptom at home post discharge and take necessary steps to maintain a healthy lifestyle.

Special thanks to Kim Erwin and Jennifer Sculley

Led a student team through research, synthesis and development of the discharge tool. Over the summer, I conducted;

  • Secondary research, covering the current education material and understanding why it doesn't work.

  • Primary research (interview, observation and shadowing) in both in-patient and out-patient setting. Direct contact with patient, caregiver and the medical staff.

  • Understanding the workflow and information flow to understand the best education delivery point.

  • Review on the 'provotypes' with different possible touch points

  • Co-conducting patient focus groups to review the prototype

STAKEHOLDER ENGAGEMENT THROUGHOUT THE PROJECT

A quick overview of all the practitioners we engaged with during this project.

PHASE 1

Understanding the context: Current education material

The current education material does not work and here's why...

Resource materials are text heavy and written at 11-12 reading grade level. 

There are few relevant visuals and the information is mostly general.

Doctors often write or sketch on post-its to educate the patients about their condition. The current education material does not facilitate that.

Current material does not prepare for the change in medication due to patient's insurance coverage.

Currently the education material serves the purpose of a handout rather than facilitating a conversation between the medical staff and the patient. 

Current material doesn't call out important information regarding self management or the additional resources available for the patient.

The current education material does not support the real environment...

The current education material is provided to the patient during discharge which is a high stress point for the patient to retain important information.

In the current education delivery system, there is no assigned point of contact. Patients get varied information from different sources.

Due to lack of an assigned job, often key information delivery points get missed.

PHASE 1

Understanding the context: Current patient journey

UNDERSTANDING HEALTH SYSTEM + STAKEHOLDERS + WORKFLOW

Critical time of care;

COPD self-management interventions can reduce re-hospitalization.

No consistency in the education provided to the patient at different points of care

No variation in education given to a new COPD patient vs someone at a severe stage. Redundant information.

Medical staff works in silos. There are key members in COPD care who are not often part of the medical rounds which disrupts the patient education during the entire process

PHASE 2

'Provotype' development

Design principles...

...equip patients with critical treatment plan information to promote continuity of care.

...address the medication translation process from home to hospital to home.

...support conversations in real-world conditions.

 

...serve as a reminder of self-management education back at home.

 

...promote the benefits of using medication appropriately.

Three concepts...

...standardize plain-language explanations of medications across educators.

 

...optimize use of limited staff resources and time constraints.

Stepping up care

Decision tree concept

Patient engagement concept

Activity map + different touchpoints | Prototype use opportunities

Reviews + prepares the patient for better hospital to home transition. Asks for any questions.

Introduces appropriate use of controller + reliever inhaler

Introduces appropriate use of controller + reliever inhaler, Inhaler education when possible

Fills in medication details, reviews 'what to take' and 'when to take' medications; set expectations for any medication change

Reviews + prepares the patient for better hospital to home transition. Asks for any questions.

Refers to tools to ask questions

Updates the medications  based on insurance coverage.

Refers to action plan at home; refers to the back page to prepare for outpatient appointment

Refers to tools to ask questions

Quickly reviews the regimen patient left the hospital on + any preparation patient comes in with

Ideally provides consistent, updated education material for patients to use post follow up

Refers to the tools to support medication + symptom recognition conversations

'Provotype' review with the clinicians...

After developing the three versions of the 'provotype' we took them to the clinicians responsible for patient education to promt a conversation and get their feedback. In this process we got feedback from the respiratory Therapists, Clinical Pharmacists and Out-Patient Pulmonologists.

PHASE 3

Prototype development

New team onboarding + Re-defining challenges

This phase of the project started in the fall as part of a faculty research project where I was invited back to lead a student team through the next stage of developing the discussion guide. In three months we went from 3 'provotypes' to two final designs going through 21 versions.

Special thanks to Kyungtae Kim and Xuning Guo for being such an amazing team and making this project even more special.

GOING BACK TO THE RESEARCH

MERIT Framework

The merit (multi-level requirements) framework is for evaluating existing interventions and creating new interventions. User requirements support the goals, roles, and responsibilities of each stakeholder group and context requirements support the interactions, workflow, and communication.

User and context 

CHALLENGE 1

Filling the gap inside the

medical team

COPD patient education at UI Health is like an orchestra without a conductor.

 

Even though there are great resources and lots of patient education happening,  guiding force that aligns all the resources in order to make one seamless experience is missing

User and context 

CHALLENGE 2

Current material is seen as a hand out and does not promote discussion

Materials need to promote mored balanced conversation between patients and the medical team instead of one-sided communication from the doctors

User and context 

CHALLENGE 3

Understanding the community and culture

Design need to be mindful of stakeholders who are actually going to use the material.

 

Patients in UI health are oriented towards direct language, action and concrete information but also are looking for nurturing tone

Content

CHALLENGE 1

Use accessible language

Text based directions and rules tend to be overwhelming due to the fact that often the reading level is quite high, which is 1016 words and 8.7 reading grade level.

This leads to missed opportunities to be proactive about taking certain steps, and possible mistakes in the process as well.

Content

CHALLENGE 2

Visual and Scannable contents

Understandable visual at the critical moments that stakeholders can easily recognize without any contents and text is necessary.

Also, according to COPD patients average age being over 50s, we need to consider line length, typography, white space, image, color/contrast.

Content

CHALLENGE 3

Action oriented content

Materials should have clear messages that tells the users what to do with relatable language. 

Re-defining the design principles

Based on the previous design principles and new research learnings, the team came up with 3 design principles that set up as a baseline for the features on the deliverables. Design principles branched out to the need statement to inform our decision-making, this is our guiding piece. 

Full size version + portable pocket size guide

DESIGN OUTCOME

FULL SIZE VERSION

The essence of the full-size version is to challenge the nature of the existing education material.

 

Currently, it’s a one-way conversation piece between the medical team and the patient, however, our idea is to create a discussion guide facilitating a conversation with different members of the medical team and empowering patients with relevant information.

From hospitalization, patients will go through many medical teams. Respiratory therapists, nurses, and pharmacists will gradually build the document together with the patients, using it as a note, guide and a conversation supporter. 

Word Count: 872

Reading Grade: 5.2

PORTABLE VERSION: AT HOME CARE

The essence of the portable version is to implement timely delivery of important medication and symptom recognition education to the patient ‘on the go’.

 

It acts as a cheat sheet for the patients to always keep with themselves to double-check and also provide in-time support to better manage their condition.

The portable document contains

1. Capturing medication change due to insurance

2. Document the medication intake and prepare for follow up

3. Re-emphasize on symptom recognition

4. Introduce proper use of an inhaler

Word count: 425

Reading Grade: 5.4

DESIGN DETAILS

Make the most of the resources + education opportunities available

 

Give the right information at the right time

 

Promote action, give context

Features inside the document were developed from the design principles

Each color indicates design principles where you can trace back to.

POCKET SIZE GUIDE

IMPACT + NEXT STEPS

As uncovered from research and prototype testing, these communication tools are the first step in a system of solutions.

At the end of the project, our team proposed and presented the discharge tools and research insights to the UIC Health system and RHA board members, the tools had potential impacts on 8,700 diagnosed COPD patients in the south-west side of Chicago.

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Special thanks to the team at IIT Institute of design + Institute of Healthcare Delivery Design + UI Health + RHA