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Gamification as a means to manage chronic disease

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UPMC is exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.

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Gamification as a means to manage chronic disease

  1. 1. September 9, 2014 Amy Ranier, Director, Patient Experience Communications, UPMC Todd Pollock, Quality Manager, Donald D. Wolff Jr. Center for Quality, Safety & Innovation at UPMC Gamification as a Means to Manage Chronic Disease
  2. 2. • A world-renowned health care provider and insurer based in Pittsburgh that strives to invent new models of accountable, cost-effective, patient-centered care • The largest non-governmental employer in Pennsylvania, with more than 62,000 employees • A nonprofit that melds an unwavering community mission with entrepreneurial business models Who is UPMC? 2
  3. 3. • More than 20 academic, community, and specialty hospitals and 400 outpatient sites; employs more than 3,500 physicians; offers an array of rehabilitation, retirement, and long-term care facilities – More than 264,000 inpatient admissions and observation cases – More than 3.6 million outpatient visits – Nearly 650,000 emergency visits – Nearly 174,000 surgeries – More than 500,000 home care visits Who is UPMC? 3
  4. 4. Until recently, UPMC’s patient education was decentralized, resulting in lack of clear direction and consistency for patients. Mission • Prepare patients and health plan members for safe passage throughout the health care continuum • Improve health outcomes through education and self-management strategies Patient Education and Engagement at UPMC 4
  5. 5. Vision • Transform the current system of providing patient education into a more comprehensive systemwide approach throughout UPMC. • Engage patients, their families, UPMC Health Plan members, and our health care professionals. With support by parallel efforts such as The Beckwith Institute, we are exploring ways to better engage patients through shared decision making and new approaches to encourage patients and their families to take control of their health. Patient Education and Engagement at UPMC 5
  6. 6. No more time! No more staff! No more money! Future of Health Care 6
  7. 7. Simplification of Heart Failure Education Content 7 Created a snapshot one-pager of “Just the Facts” Reduced HF education book from 41 pages to 16 pages
  8. 8. • What if we converted “Just the Facts” to a platform that would engage patients and get them to focus on 3 critical survival skills? 1. Medication Compliance 2. Daily Weighing and Reporting Symptoms 3. Schedule and Attend Follow-up Physician Appointment  within 7 days of discharge (inpatient)  if symptoms occur (outpatient) Simplification: What If…? 8
  9. 9. • What if we took the techniques that have proved successful in adult learning and applied them to heart failure? • What if we took the principals of gaming and used them to make learning about heart failure easier and fun? Simplification: What If…? 9
  10. 10. • Complex Patients • Readmission Risk – Nearly 25% of patients hospitalized with heart failure are readmitted within 30 days – An analysis of Medicare claims data from 2007 to 2009 found that 35% of those readmissions within 30 days were for HF • Behavior Change is Key Source: Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure, Feltner, et al; Annals of Internal Medicine Volume 160, June 30, 2014 Why Tackle Heart Failure? 10
  11. 11. Goal Through patient education, influence patient knowledge and behavior to reduce heart failure readmissions during the first 30 days after discharge. Why Tackle Heart Failure? 11
  12. 12. • Etcetera Edutainment (EE) is the leader in delivering video games that drive learning and behavior change. • January 2005 spinout of Carnegie Mellon University – Internationally renowned for combining game development + learning + design + engineering • EE’s platform, simcoach® is a framework for delivering game-based products for assessment, teaching, practice, and ongoing coaching of critical behaviors – simcoach® products focus on a few key skills that will have the biggest impact on a measurable outcome. Meet Etcetera Edutainment… 12
  13. 13. simcoach® Platform in Other Industries 13
  14. 14. simcoach® platform leverages qualities of games proven to facilitate learning and motivate behavior change: 1. Goals 2. Active Participation 3. Consequences 4. Feedback Why Video Gaming? 14
  15. 15. • Active Focus – Player (patient) must make choices to proceed through the game (material) – Choices have consequences/ immediate feedback – “Doing,” not watching – we know this is how adults learn best • Critical Skills – Limited to a few critical behaviors that we want to drive in to cement habits – Show their choices’ impact on health outcomes and also that there are skills they can apply right away towards a healthy lifestyle/outcomes. – Patient education is often overwhelming, with long lists of dos/don’ts • Consistency – Traditional patient education delivered by clinicians who are diverse in their comfort as educators Using Gaming Principles vs. Traditional Patient Education 15
  16. 16. • Patients (Research, Play Testing) • Cardiologists • Pharmacists • Unit Directors • Staff Nurses • UPMC Patient Experience Communications • UPMC Center for Quality Improvement and Innovation • Etcetera Edutainment The Original Pilot Team 16
  17. 17. • Interviewed and observed CHF patients: – Confusion… "I'm still in the dark." "It's gone by in a blur." • Weighing vs. weight loss – Denial…"I just need to be at home." – Powerlessness… “Ain’t nothing you can do. Just take your meds and hope.” The Approach 17
  18. 18. • Weekly meetings • Play testing! • Pilot rollout at one unit in one hospital • Refine, expand, refine The Approach 18
  19. 19. UPMC eHealth Coach Demo (Version 1.0) 19
  20. 20. What Our Patients and Nurses Told Us – Notes from Initial Pilot 20 Loved the program! (Patient, 92) Patient felt it was useful and liked it; would like to be able to get app at home. (Nurse) Useful! Played it until I got it right! (Patient) A good teaching tool to discuss with patient. Patient stated it was an "excellent" tool. (Nurse)
  21. 21. Initial Pilot Results – UPMC Mercy Hospital 21 Knowledge Testing: Patient Group No Change in Test Results Improved Knowledge Pre-Pilot (n=21) 13 8 Pilot (n=20) 5 15 Survival Skill Compliance: Patient Group Checking Weight Daily Taking Meds Follow-up MD Appt Attended All Mercy HF Patients (n=85) 61% 82% 78% Pilot (n=10) 90% 100% 80% 1* Patient Readmitted from Pilot Group vs. None from Pre-Pilot
  22. 22. Initial Pilot: One Hospital, One Unit 22
  23. 23. • Patients are interested and engaged • Families are participating • Nurses love it • Sustainable • Scalable to other diseases/conditions Results – Why This is Worth Continuing 23
  24. 24. • Simplify setup to improve workflow for nurses • Adjust for deployment in both inpatient and outpatient settings • Make Simon a character, separate from player • Evolve interaction to be dialogue between player and Simon Version 2.0 – What’s New 24
  25. 25. Version 2.0 Demo 25
  26. 26. • iOS (iPad and iPad Mini) • Windows (Surface Pro 3) • Android (Tablet) • Web Version 2.0 – Devices/Platforms 26
  27. 27. Todd Pollock Manager, Center for Quality Improvement & Innovation pollocktp@upmc.edu 412-802-8077 Amy Ranier Director, Patient Experience Communications ranierak@upmc.edu 412-647-1396 Thank You! 27

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