Browsing by Author "Holden, Richard"

Now showing 1 - 8 of 8
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    A big data augmented analytics platform to operationalize efficiencies at community clinics
    (2016-04-15) Kunjan, Kislaya; Jones, Josette F.; Toscos, Tammy; Wu, Huanmei; Holden, Richard
    Community Health Centers (CHCs) play a pivotal role in delivery of primary healthcare to the underserved, yet have not benefited from a modern data analytics platform that can support clinical, operational and financial decision making across the continuum of care. This research is based on a systems redesign collaborative of seven CHC organizations spread across Indiana to improve efficiency and access to care. Three research questions (RQs) formed the basis of this research, each of which seeks to address known knowledge gaps in the literature and identify areas for future research in health informatics. The first RQ seeks to understand the information needs to support operations at CHCs and implement an information architecture to support those needs. The second RQ leverages the implemented data infrastructure to evaluate how advanced analytics can guide open access scheduling – a specific use case of this research. Finally, the third RQ seeks to understand how the data can be visualized to support decision making among varying roles in CHCs. Based on the unique work and information flow needs uncovered at these CHCs, an end to-end analytics solution was designed, developed and validated within the framework of a rapid learning health system. The solution comprised of a novel heterogeneous longitudinal clinic data warehouse augmented with big data technologies and dashboard visualizations to inform CHCs regarding operational priorities and to support engagement in the systems redesign initiative. Application of predictive analytics on the health center data guided the implementation of open access scheduling and up to a 15% reduction in the missed appointment rates. Performance measures of importance to specific job profiles within the CHCs were uncovered. This was followed by a user-centered design of an online interactive dashboard to support rapid assessments of care delivery. The impact of the dashboard was assessed over time and formally validated through a usability study involving cognitive task analysis and a system usability scale questionnaire. Wider scale implementation of the data aggregation and analytics platform through regional health information networks could better support a range of health system redesign initiatives in order to address the national ‘triple aim’ of healthcare.
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    From Model Organisms to Humans, the Opportunity for More Rigor in Methodologic and Statistical Analysis, Design, and Interpretation of Aging and Senescence Research
    (Oxford University Press, 2022) Chusyd, Daniella E.; Austad, Steven N.; Brown, Andrew W.; Chen, Xiwei; Dickinson, Stephanie L.; Ejima, Keisuke; Fluharty, David; Golzarri-Arroyo, Lilian; Holden, Richard; Jamshidi-Naeini, Yasaman; Landsittel, Doug; Lartey, Stella; Mannix, Edward; Vorland, Colby J.; Allison, David B.; Anatomy, Cell Biology and Physiology, School of Medicine
    This review identifies frequent design and analysis errors in aging and senescence research and discusses best practices in study design, statistical methods, analyses, and interpretation. Recommendations are offered for how to avoid these problems. The following issues are addressed: (a) errors in randomization, (b) errors related to testing within-group instead of between-group differences, (c) failing to account for clustering, (d) failing to consider interference effects, (e) standardizing metrics of effect size, (f) maximum life-span testing, (g) testing for effects beyond the mean, (h) tests for power and sample size, (i) compression of morbidity versus survival curve squaring, and (j) other hot topics, including modeling high-dimensional data and complex relationships and assessing model assumptions and biases. We hope that bringing increased awareness of these topics to the scientific community will emphasize the importance of employing sound statistical practices in all aspects of aging and senescence research.
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    Human factors analysis, design, and evaluation of Engage, a consumer health IT application for geriatric heart failure self-care
    (Taylor & Francis:, 2017) Srinivas, Preethi; Cornet, Victor; Holden, Richard; BioHealth Informatics, School of Informatics and Computing
    Human factors and ergonomics (HFE) and related approaches can be used to enhance research and development of consumer-facing health IT systems, including technologies supporting the needs of people with chronic disease. We describe a multiphase HFE study of health IT supporting self-care of chronic heart failure by older adults. The study was based on HFE frameworks of "patient work" and incorporated the three broad phases of user-centered design: study or analysis; design; and evaluation. In the study phase, data from observations, interviews, surveys, and other methods were analyzed to identify gaps in and requirements for supporting heart failure self-care. The design phase applied findings from the study phase throughout an iterative process, culminating in the design of the Engage application, a product intended for continuous use over 30 days to stimulate self-care engagement, behavior, and knowledge. During the evaluation phase, we identified a variety of usability issues through expert heuristic evaluation and laboratory-based usability testing. We discuss the implications of our findings regarding heart failure self-care in older adults and the methodological challenges of rapid translational field research and development in this domain.
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    Identifying Metaphors Used by Clinicians That Help Patients Conceptualize Complex Cardiac Device Data for Managing Their Health
    (2021-12) Daley, Carly Noel; Holden, Richard; Jones, Josette; Bolchini, Davide; Bute, Jennifer
    Metaphors are used to conceptualize one thing in terms of another that is more familiar or concrete. The use of metaphors in patient-provider communication has helped providers generate empathy and explain concepts effectively, improving patient satisfaction and understanding of health-related concepts. With advances in technology, concepts related to health monitoring have become increasingly complex, making the potential for using metaphors in health communication at its highest relevancy. With the increase in health data there is a need to improve tools to help people understand complex information. Ethical considerations, such as possible misinterpretation of health data, as well as the potential to widen disparities because of factors such as health literacy, must be addressed. Metaphors are powerful tools that can make explanation of information accessible, accurate, and effective for people who are monitoring their data. The current research aims to contribute design recommendations for using metaphors in communication between clinicians and patients for monitoring biventricular (BiV) pacing, a complex device data element used in the monitoring of patients with heart failure (HF) who have cardiac resynchronization therapy (CRT) devices. The overarching goal is to understand this process such that it can be applied to broader communication needs in health informatics. The study addresses the following aims: Aim 1: Identify metaphors clinicians use to conceptualize BiV pacing for CRT devices using semi-structured interviews with clinician experts. Aim 2: Identify metaphors that help patients conceptualize BiV pacing for CRT devices using semi-structured interviews with patients, and exploring the metaphors identified in Aim 1. Aim 3: Develop design recommendations for health informatics interventions using an understanding of metaphors that help patients understand BiV pacing for CRT devices. Themes from analysis of Aims 1 and 2 contribute to recommendations for the use of metaphors in health informatics interventions. The purpose of this work is to contribute to an in-depth understanding of metaphors in a specific health informatics context. Importantly, this research applies methods and principles from the field of health communication to address a communication-related issue in health informatics.
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    Improving over-the-counter medication safety for older adults: A study protocol for a demonstration and dissemination study
    (Elsevier, 2017-09) Chui, Michelle A.; Stone, Jamie A.; Holden, Richard; Medicine, School of Medicine
    BACKGROUND: Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medication. OBJECTIVES: To refine the intervention and implementation strategy through diagnostic and formative evaluation; to evaluate the effectiveness of the intervention for preventing misuse of high-risk OTC medications by older adults; and to evaluate the implementation of the intervention in community pharmacies. METHODS: A system redesign intervention to decrease high-risk OTC medication misuse will be tested to reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult's health status. The study will be conducted in three phases: a participatory design phase, a beta phase, and a test phase. The test phase will be conducted in three mass-merchandise stores. A total of 144 older adults will be recruited. A pre (control)/post (intervention) test will determine the effectiveness of the intervention. The primary outcome will be a comparison of proportion of older adults who misuse OTC medication from baseline to post-intervention. The process of implementation in the community pharmacy setting will be evaluated using the taxonomy proposed by Proctor et al. The participatory design phase has been approved by the institution's IRB (2016-0743). PROJECTED IMPACT: It is anticipated that this project, which focuses on achieving systems-based improvement in an underemphasized area of the medication use process, will reduce ADEs associated with inappropriate OTC medication use in older adults.
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    Mobile Enhancement of Motivation in Schizophrenia: A Pilot Randomized Controlled Trial of a Personalized Text Message Intervention for Motivation Deficits
    (APA, 2020-10) Luther, Lauren; Holden, Richard; McCormick, Bryan; Fischer, Melanie W.; Johnson-Kwochka, Annalee V.; Minor, Kyle S.; Lapish, Chris L.; Salyers, Michelle P.; Psychology, School of Science
    Objective: Motivation deficits remain an unmet treatment need in schizophrenia. Recent research has identified mechanisms underlying motivation deficits (i.e., impaired effort-cost computations, reduced future reward-value representation maintenance) that may be effective treatment targets to improve motivation. This study tested the feasibility and preliminary effectiveness of Mobile Enhancement of Motivation in Schizophrenia (MEMS), an intervention that leverages mobile technology to target these mechanisms with text messages. Method: Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (n = 27) or a control condition (n = 29). All participants set recovery goals to complete over 8 weeks. Participants in the MEMS group additionally received personalized, interactive text messages on their personal cellphones each weekday. Results: Retention and engagement in MEMS were high: 92.6% completed 8 weeks of MEMS, with an 86.1% text message response rate, and 100% reported being satisfied with the text messages. Compared to participants in the control condition, the participants in the MEMS condition had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and attained significantly more recovery-oriented goals at 8 weeks. There were no significant group differences in purported mechanisms (performance-based effort-cost computations and future reward-value representations) or in self-reported motivation, quality of life, or functioning. Conclusion: Results demonstrate that MEMS is feasible as a brief, low-intensity mobile intervention that could effectively improve some aspects of motivation (i.e., initiation and maintenance of goal-directed behaviors) and recovery goal attainment for those with schizophrenia-spectrum disorders. More work is needed with larger samples and to understand the mechanisms of change in MEMS.
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    Task, Usability, and Error Analyses of Ambulance-based Telemedicine for Stroke Care
    (Taylor & Francis, 2021) Rogers, Hunter; Madathil, Kapil Chalil; Joseph, Anjali; McNeese, Nathan; Holmstedt, Christine; Holden, Richard; McElligott, James T.; Medicine, School of Medicine
    Past research has established that telemedicine improves stroke care through decreased time to treatment and more accurate diagnoses. The goals of this study were to 1) study how clinicians complete stroke assessment using a telemedicine system integrated in ambulances, 2) determine potential errors and usability issues when using the system, and 3) develop recommendations to mitigate these issues. This study investigated use of a telemedicine platform to evaluate a stroke patient in an ambulance with a geographically distributed caregiving team comprised of a paramedic, nurse, and neurologist. It first determined the tasks involved based on 13 observations of a simulated stroke using 39 care providers. Based on these observational studies, a Hierarchical Task Analysis (HTA) was developed, and subsequently, a heuristic evaluation was conducted to determine the usability issues in the interface of the telemedicine system. This was followed by a Systematic Human Error Reduction and Prediction Approach (SHERPA) to determine the possibility of human error while providing care using the telemedicine work system. The results from the HTA included 6 primary subgoals categorizing the 97 tasks to complete the stroke evaluation. The heuristic evaluation found 123 unique violations to heuristics, with an average severity of 2.38. One hundred and thirty-one potential human errors were found with SHERPA, the two most common being miscommunication and selecting an incorrect option. Several recommendations are proposed, including improvement of labeling, consistent formatting, rigid or suggested formatting for data input, automation of task structure and camera movement, and audio/visual improvements to support communication.
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    User Personas to Guide Technology Intervention Design to Support Caregiver-Assisted Medication Management
    (Oxford, 2022-11) Linden, Anna; Loganathar, Priya; Holden, Richard; Boustani, Malaz; Campbell, Noll; Ganci, Aaron; Werner, Nicole; Herron School of Art
    Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.