Following-up with a PCP after ED visit

Designing a communication

patient-facing tool

Team

Cristina Tarriba

Çagla Kuzu

Advisors

Kim Erwin

Hugh Musick

Organization

Institute for Healthcare Delivery Design

Date

May-August 2018

PCP Follow-up guide

Helps patients schedule an appointment with a PCP after visiting the Emergency Department

Project space at UI Health

PCP Follow-up guide

Helps patients schedule an appointment with a PCP after visiting the Emergency Department

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Project brief

We were asked to help promote patient follow-up with Primary Care Physicians after visiting the Emergency Department to potentially decrease the number of patients visiting the ED for

non-emergency medical visits.

My role

I conducted research (stakeholder interviews, observations, etc). Synthesized primary research into frameworks and prototyped several versions of our concept.

The problem

The emergency department at UI Health receives an increasing number of patients that often don’t need urgent medical care but because of lack of awareness and information around PCP, they end up going to the ED. Additionally, resistance to assist their follow-up appointments with a PCP after their ED visit increases the probability that they will come back to the ER with the same condition. This represents expenses for the hospital as well as for patients.

Results

Currently, the follow-up guide is being distributed to patients at the Emergency Department at UI Health.

According to the Patient Navigator at UI Health, the number of patients that schedule and attend their follow-up appointments has increased since the follow-up guide started to be distributed.

After our final presentation, the Director of the ED approved the redesign of additional documents distributed at the ED.

Key personal learnings

The power of inclusive communication design: I learned how to run Flesch-Kincaid readability tests to evaluate the reading ease and the grade level and to design according to low health literacy guidelines.

Diagrams as alignment tools for stakeholders: The patient journey diagram allowed us to shed light on unintended consequences regarding the amount of paperwork given to patients and the poor quality of the documents in regards to reading ease and grade level. Additionally, the diagram enabled key stakeholders to quickly understand the experience of patients and to make better decisions as a group.

Prototyping as an extension of research: Using provotypes early on to get a sense of what resonated with the ED staff and patients was extremely useful to understand their needs, communicate, and test ideas with them.

Conducting research in the Emergency Department

Throughout our project, we conducted various types of research. This iterative research process allowed us to keep learning along the process and incorporate new findings into our following concept proposals.

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OBSERVATIONS +

SHADOWING

ROLE PLAY

IN-DEPTH

INTERVIEWS

PROVOTYPES

AB TESTING

ED patient navigator
6 patients
3 ED staff

ED patient navigator

ED patient navigator
2 social workers
1 financial case manager

Co-creation session with ED patient navigator

9 patients
2 caregivers

Content analysis of patients' journey at ED

Insights from content analysis

1. Patients receive a lot of documents

Total pages: 19

Total words: 7668

2. Documents aren’t fitting to health

literacy guidelines

Average reading ease: 45%

*Optima level: 60-70%

Average grade level: 10th grade

*Optima level: 4th-6th grade

3. Documents provide actionable steps

Total action items: up to 8 (3 given to each patient, 5 when applicable)

Key findings

Barriers for patients to connect with a PCP

There is unawareness and confusion around having and managing a PCP.

It's unclear for patients to know how to follow-up if they don’t have insurance.

Patients usually don’t receive guidance in relation to getting a follow-up appointment.

Patients forget to set a follow-up appointment after their visit to the ED

Patients aren’t fully aware of UIC clinics and its primary care options.

Previous long waiting times or no availability for appointments, make patients believe they will not be able to get an appointment.

Connecting emotionally with patients and dissolving barriers against getting a PCP.

Enablers for patients to connect with a PCP

Explanation in plain language about what a PCP is and its benefits.

Makes reminders of key steps in the process of getting a PCP appointment.

Encouraging patients to take action and emphasize what the next step to schedule an appointment is.

Customizing information relevant to each patient.

Multi-stakeholder requirements framework

For the communication piece to be successful and effective it needed to be aligned with all of the requirements. We distilled the needs of key users (patients and medical navigator) considering requirements at three different levels: content, user, and contextual requirements.

Provotypes A key component of our research

Exploring potential solutions

Testing different approaches for content and flow

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Early in our research phase, we used provotypes. A provotype is a prototype that provokes. It causes reactions and engages people to imagine possible solutions for any given problem.

Prototypes Understanding usability

Once we had a more solid concept we explored different ways of presenting information. We created different prototypes to understand how patients and caregivers would interact with the follow-up guide and how and if they were going to be useful. This allowed us to understand what aspects of the concept worked and which ones needed to be redefined.

Refined version

After many prototypes, we arrived at the following solution. Below is the current version that is distributed at the hospital today.

AB Testing Understanding preference

We used AB testing to understand the preferences among patients of the old version compared to the one we were proposing. This was very helpful to identify what document was supporting patients to schedule an appointment with a PCP.