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Joseph Cafazzo, PhD PEng Patient: Heal Thyself: The use of technology to facilitate patient self-care ISHSH 2013

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Presentation given by Joseph Cafazzo at ISHSH 2013

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Page 1: Patient: Heal Thyself: The use of technology to facilitate patient self-care

Joseph Cafazzo, PhD PEng

Patient: Heal Thyself:The use of technology to facilitate patient self-care

ISHSH 2013

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EMPATHYin design

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‘Shift Left’ of Healthcare through Technology1

$1 $10 $100 $1,000 $10,000

0%

100%

COST of CARE/DAY

QUALITYof LIFE

Healthy, Independent Living

Chronic Disease Management Doctor’s

Office

Community Clinic

HOME CARE and LTC

Assisted Living

Skilled Nursing Facility

RESIDENTIAL CARE

Community Hospital

ICU

Specialty Clinic

ACUTE CARE

1) from Intel, and Center for Aging Services Technologies (CAST)

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PATIENTSELF-CARE

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EMPATHYin design

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BUILD

CONCEPT

EVIDENCE

EVALUATE

DESIGNEMPATHY

in design

USABILITY

PILOTS and RCTs

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Poor Design

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“We have a serious training problem that needs to be corrected”“We need to know how our equipment works: when the battery is changed, it defaults to its own location.” “We’ve got to make sure our people understand this”Senior Air Force Official

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Adverse Events in Healthcare

• IOM 1999: 44, 000 to 98, 000 US deaths annually due to medical error

• Baker, Norton 2004: 9, 000 to 23, 000 deaths annually due to preventable adverse events

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Solis PCA Pump

3.5 years

12 iterations

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Export to PDFExport to PDF

Early Software and Hardware Prototypes

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High Fidelity Usability Testing

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– Latch design– LED placement– Remote dose cord feedback– Lock rotation direction– Battery compartment closure

Hardware Design

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Screen Design• Visibility of pump status

• Drug name & concentration

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Workflow Design• Task-based Menu Structure

• Therapy/Qualifier/Drug

• Streamlined pump programming sequence

• Consistent with pump programming software

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Export to PDFExport to PDF

Solis VIP

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Impact

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PATIENTSELF-CARE

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51

NDNG

http://www.flickr.com/photos/ndguard/
http://www.flickr.com/photos/ndguard/
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Improved Health Outcomes : Home Hemodialysis

– Normalization of blood pressure without the need for anti-hypertensive medications– Normalization of abnormal wall thickness of the heart– Restoration of impaired heart function– Improvement in peripheral circulation– Improvement in sleep quality– Improvement in nutritional determinants– Elimination of dietary restriction

• Patient autonomy• Cost effective modalityChan et al : KI, 2002, Chan et al: NDT, 2003 Chan et al: AJKD, 2003,

Hanly et al: NEJM, 2001Pierratos et al: JASN, 1998

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Patient-Perceived Barriers to Home Hemodialysis(Cafazzo and Chan, 2007)

• Perceived burden on family members

• Fear of self-cannulation

• Fear of a catastrophic event in the absence of nursing support

• Low self-efficacy

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58

quecojonesNomadicEntrepreneur

http://www.flickr.com/photos/quecojones/
http://www.flickr.com/photos/quecojones/
http://www.flickr.com/photos/nomadicentrepreneur/
http://www.flickr.com/photos/nomadicentrepreneur/
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64

So if patients can do a highly invasive, potentially fatal therapy at home successfully with improved health outcomes and lower cost

then ....

WHAT ELSE CAN PATIENTS DO?

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Available in ten languages

Néih hóu

Bonjour Guten Tag

Zdravstvuite

Buenos días

Nî hâo

Annyong ashimnikka

Hello

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Downloads:>80,000

more than10,000 active

daily users

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THEME: Fast, discrete transactions:

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Glooko

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iBGStar

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85

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“… thought about trends and what to do when the alert popped up”

“… I tested more often at lunch”

“… rewards motivated me to test more”

“… she initiated more conversations about her blood sugars”

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Type I(Lisa Min) Type 2

(Shivani Goyal)

Artificial Pancreas(Isabelle Dutil)

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The (near) future: The Artificial Pancreas

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The goal:

mHealthAP dashboard

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BLOOD PRESSURE TRANSMITTEDAUTOMATICALLY TO BLACKBERRY

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American Journal of Hypertension, 20(9), pp. 942-948, 2007

Pilot ResultsDiabetic Hypertension

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NO CHANGE - 9.1 mmHg systolic

- 4.6 mmHg diastolic

+

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SELF AWARENESSMED ADHERENCE

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70,000 downloads15,000 > 2 weeks6,000 all 30 days

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App Definition Statement

Help people control their Asthma through tracking, reminders, trend analysis,

environmental health factors, and easy access to their Asthma Action Plan.

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Export to PDFExport to PDF

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Congestive Heart Failure Client

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RCT Study design

• N=100

• duration 6 months

• daily measurements before 10 am - reminder call

• alert algorithm - messages direct to cardiologist

• control group - usual care

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RCT ResultsCongestive Heart Failure

150 pg/mLBNP

7.4 %LVEF

no change in the control group

7 pointsself-care

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@JosephCafazzo


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