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Scheer ER, Werner NE, Coller RJ, Nacht CL, Petty L, Tang M, Ehlenbach M, Kelly MM, Finesilver S, Warner G, Katz B, Keim-Malpass J, Lunsford CD, Letzkus L, Desai SS, Valdez RS. Designing for caregiving networks: a case study of primary caregivers of children with medical complexity. J Am Med Inform Assoc 2024; 31:1151-1162. [PMID: 38427845 PMCID: PMC11031225 DOI: 10.1093/jamia/ocae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. MATERIALS AND METHODS We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. RESULTS Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. DISCUSSION Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. CONCLUSION This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.
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Affiliation(s)
- Eleanore Rae Scheer
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, United States
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA 92182, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92093, United States
| | - Lauren Petty
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Mengwei Tang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Sara Finesilver
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI 53705, United States
| | - Jessica Keim-Malpass
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Christopher D Lunsford
- Department of Orthopedics, Duke University, Durham, NC 27710, United States
- Department of Pediatrics, Duke University, Durham, NC 27707, United States
| | - Lisa Letzkus
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Shaalini Sanjiv Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
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Jolliff A, Coller RJ, Kearney H, Warner G, Feinstein JA, Chui MA, O'Brien S, Willey M, Katz B, Bach TD, Werner NE. An mHealth Design to Promote Medication Safety in Children with Medical Complexity. Appl Clin Inform 2024; 15:45-54. [PMID: 37989249 PMCID: PMC10794091 DOI: 10.1055/a-2214-8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Children with medical complexity (CMC) are uniquely vulnerable to medication errors and preventable adverse drug events because of their extreme polypharmacy, medical fragility, and reliance on complicated medication schedules and routes managed by undersupported family caregivers. There is an opportunity to improve CMC outcomes by designing health information technologies that support medication administration accuracy, timeliness, and communication within CMC caregiving networks. OBJECTIVES The present study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a codesign process to identify: (1) medication safety challenges experienced by CMC caregivers and (2) design requirements for a mobile health application to improve medication safety for CMC in the home. METHODS Study staff recruited family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program to participate in virtual codesign sessions. During sessions, the facilitator-guided codesigners in generating and converging upon medication safety challenges and design requirements. Between sessions, the research team reviewed notes from the session to identify design specifications and modify the prototype. After design sessions concluded, each session recording was reviewed to confirm that all designer comments had been captured. RESULTS A total of N = 16 codesigners participated. Analyses yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines. Supporting quotations from codesigners and prototype features associated with each design requirement are presented. CONCLUSION This study generated design requirements for a tool that may improve medication safety by creating distributed situation awareness within the caregiving network. The next steps are to pilot test tools that integrate these design requirements for usability and feasibility, and to conduct a randomized control trial to determine if use of these tools reduces medication errors.
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Affiliation(s)
- Anna Jolliff
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Hannah Kearney
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michelle A. Chui
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Steve O'Brien
- Noble Applications, Madison, Wisconsin, United States
| | - Misty Willey
- Noble Applications, Madison, Wisconsin, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, Wisconsin, United States
| | - Theodore D. Bach
- Department of Pediatrics, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Nicole E. Werner
- Department of Health and Wellness Design, Indiana University at Bloomington, Bloomington, Indiana, United States
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Xiao Y, Miller K, Werner N, Smith K, Hendrix N, Hemmelgarn C. Co-Design with Patients for Improving Patient Safety: Strategies, Barriers and pitfalls. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2023; 67:633-638. [PMID: 38213999 PMCID: PMC10782182 DOI: 10.1177/21695067231192416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
What happens when "frontline" workers are patients and family members performing health-related tasks? As more and more complex healthcare tasks are performed by patients and family members, and more emphasis is placed on patient- and family-centered care, strategies are needed to engage patients and family members in co-design "work systems" and patient-professional collaborative work. Human factors professionals are well-equipped to apply participatory ergonomics to patient and collaborative tasks. However, there are a number of barriers and pitfalls in engaging patients in design. Moving from tokenism to meaningful engagement in research requires patience, constant reflection, and a commitment to codesign. Our panel will explore the continuum of engagement and strategies to move from tokenism to partnership to cocreation in patient safety research, ranging from ambulatory medication safety to diagnosis in the emergency department. Strategies and barriers are presented as a starting point to discuss how to achieve effective work system designs.
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Affiliation(s)
- Yan Xiao
- University of Texas at Arlington,
Arlington, Texas, USA
| | - Kristen Miller
- MedStar Health and Georgetown
University, Washington, DC, USA
| | - Nicole Werner
- Indiana University Bloomington,
Bloomington, Indiana, USA
| | | | - Noah Hendrix
- University of Texas at Arlington,
Arlington, Texas, USA
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Barton HJ, Pflaster E, Loganathar S, Werner A, Tarfa A, Wilkins D, Ehlenbach ML, Katz B, Coller RJ, Valdez R, Werner NE. What makes a home? Designing home personas to represent the homes of families caring for children with medical complexity. APPLIED ERGONOMICS 2023; 106:103900. [PMID: 36122551 PMCID: PMC10072316 DOI: 10.1016/j.apergo.2022.103900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
Personas are widely recognized as valuable design tools for communicating dimensions of individuals, yet they often lack critical contextual factors. For those people managing chronic health conditions, the home is a critical context of their patient work system (PWS). We propose the development of 'home personas' to convey essential aspects of the home context to those tasked with designing technologies and interventions to fit it. We used an iterative, multi-stakeholder design process to design 'home personas' for a model population, families caring for children with medical complexity. Each of the four resultant home personas-Multi-level, Customized, Ranch, and Rental-has a unique home layout, pain points, and are described on three dimensions that emerged from the data. This study builds on a foundation of work in the emerging field of Patient Ergonomics, describing a mechanism for distilling rich descriptions of the PWS into brief yet informative design tools.
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Affiliation(s)
- Hanna J Barton
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Ellen Pflaster
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Shanmugapriya Loganathar
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Allison Werner
- School of Human Ecology, University of Wisconsin-Madison, United States
| | - Adati Tarfa
- School of Pharmacy, University of Wisconsin-Madison, United States
| | - David Wilkins
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, United States
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | | | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, United States
| | - Rupa Valdez
- Department of Public Health Sciences and Department of Engineering Systems and Environment, University of Virginia, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, United States.
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