IU Indianapolis ScholarWorks :: Browsing by Author "Holden, Richard J."

Browsing by Author "Holden, Richard J."

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11384 Medication Use Safety During Care Transitions for Children with Medical Complexity
(Cambridge University Press, 2021) Abebe, Ephrem; Wiehe, Sarah; Holden, Richard J.; Pediatrics, School of Medicine
ABSTRACT IMPACT: This study will generate preliminary data to address a critical, care transition-related patient safety gap involving medication use among children with medical complexity. OBJECTIVES/GOALS: The objectives of this study are: (1) to understand care transition-related medication safety risks for children with medical complexity (CMC), and (2) through a participatory, human centered design (PD) approach, to develop an early prototype intervention to address identified safety risks. METHODS/STUDY POPULATION: The study population includes children with medical complexity (CMC), a medically fragile pediatric population with intensive healthcare needs. CMC rely on multiple and complex medication regimens and/or medical devices for optimal functioning. Parents of CMC report multiple unmet healthcare needs. For Aim 1, we will conduct observations and interviews with ˜15 clinicians as well as semi-structured interviews with ˜30 family caregivers during three care transition experiences: from Cardiac ICU to home, Neonatal ICU to home, and those between primary care/specialty clinic to home. For Aim 2, we will conduct participatory design sessions with up to 5 participants (separately for clinicians and family caregivers) from each of the three care transition settings to co-design a prototype intervention. RESULTS/ANTICIPATED RESULTS: The study is currently recruiting family caregivers of CMC for aim 1 research activities, with interviews planned to be completed in February/March 2021. Transcribed interviews will be used to inform development of patient journey maps. A patient journey map helps to visually depict healthcare services through the patient and family lens, and highlights important ‘touch points’ along the patient journey (e.g., decisions, encounters, constraints, emotional states, etc.) that shape the patient and family experience. The journey map will distill findings from qualitative data and generate a concise visual story focused on the medication use experience of CMC as they transition between the hospital and their home. Individual journey maps will also be combined to generate a consolidated journey map. DISCUSSION/SIGNIFICANCE OF FINDINGS: An-in-depth understanding of medication safety risks unique to the context of CMC care would be essential to develop interventions that are useful, scalable, and sustainable. This is even more important because current interventions are primarily adopted from adult care settings with mixed outcomes.
147 Transition Across Care Boundaries: Opportunities to Improve Medication Safety for Children with Medical Complexity
(Cambridge University Press, 2022) Abebe, Ephrem; Wiehe, Sarah; Holden, Richard J.; Pediatrics, School of Medicine
OBJECTIVES/GOALS: Children with medical complexity (CMC) experience frequent transitions of care (e.g., hospital to home) and are at increased risk for medication-related harm. This study aimed to identify transition-related medication safety barriers experienced by family caregivers, as they shoulder most of the caregiving responsibility following discharge. METHODS/STUDY POPULATION: We conducted semi-structured qualitative research interviews of 6 family caregivers and 10 healthcare professionals with roles assisting families during hospital discharge. Interviews focused on identifying key stages of the hospital-to-home transition period as well as medication-related tasks, decisions, and contexts. Transcribed audio interviews and research meeting notes were content analyzed to develop journey maps visually depicting key phases of the families experiences managing medication at home and their decision points and unmet needs. RESULTS/ANTICIPATED RESULTS: Journey mapping identified key decision points, medication management needs, and way points navigated by family caregivers during the hospital-to-home transition. Findings were salient for each phase of the family journey: 1) initial admission/intra-unit transfer; 2) in-patient care; 3) peri-discharge planning; 4) discharge; 5) immediate post discharge period (we termed post-discharge configuration); and 6) period of ongoing tasks and needs. Illustrative examples will be presented and discussed. DISCUSSION/SIGNIFICANCE: Family caregivers of CMC have needs that evolve throughout the medication use journey, suggesting a need for interventions that account for the time variant nature of this work. Findings lay a foundation for the next step of our study which aims to develop a prototype medication safety intervention that will be evaluated with family caregivers.
Activity Theory Analysis of Heart Failure Self-Care
(Taylor & Francis, 2018) Cornet, Victor; Voida, Stephen; Holden, Richard J.; Medicine, School of Medicine
The management of chronic health conditions such as heart failure is a complex process emerging from the activity of a network of individuals and artifacts. This article presents an Activity Theory-based secondary analysis of data from a geriatric heart failure management study. Twenty-one patients' interviews and clinic visit observations were analyzed to uncover eight configurations of roles and activities involving patients, clinicians, and others in the sociotechnical network. For each configuration or activity pattern, we identify points of tension and propose guidelines for developing interventions for future computer-supported healthcare systems.
Advocacy in Mental Health Social Interactions on Public Social Media
(2022-02) Cornet, Victor P.; Holden, Richard J.; Bolchini, Davide; Brady, Erin; Mohler, George; Hong, Michin; Lee, Sangwon
Health advocacy is a social phenomenon in which individuals and collectives attempt to raise awareness and change opinions and policies about health-related causes. Mental health advocacy is health advocacy to advance treatment, rights, and recognition of people living with a mental health condition. The Internet is reshaping how mental health advocacy is performed on a global scale, by facilitating and broadening the reach of advocacy activities, but also giving more room for opposing mental health advocacy. Another factor contributing to mental health advocacy lies in the cultural underpinnings of mental health in different societies; East Asian countries like South Korea have higher stigma attached to mental health compared to Western countries like the US. This study examines interactions about schizophrenia, a specific mental health diagnosis, on public social media (Facebook, Instagram, and Twitter) in two different languages, English and Korean, to determine how mental health advocacy and its opposition are expressed on social media. After delineation of a set of keywords for retrieval of content about schizophrenia, three months’ worth of social media posts were collected; a subset of these posts was then analyzed qualitatively using constant comparing with a proposed model describing online mental heath advocacy based on existing literature. Various expressions of light mental health advocacy, such as sharing facts about schizophrenia, and strong advocacy, showcasing offline engagement, were found in English posts; many of these expressions were however absent from the analyzed Korean posts that heavily featured jokes, insults, and criticisms. These findings were used to train machine learning classifiers to detect advocacy and counter-advocacy. The classifiers confirmed the predominance of counter-advocacy in Korean posts compared to important advocacy prevalence in English posts. These findings informed culturally sensitive recommendations for social media uses by mental health advocates and implications for international social media studies in human-computer interaction.
After Visit Summary: Not an Afterthought
(Sage, 2019-09) Sieferd, Edward; Mohanty, Nivedita; Holden, Richard J.; Medicine, School of Medicine
The After Visit Summary (AVS) is provided to patients after clinical visits to summarize what happened during the visit and guide future care. Despite its potential to improve shared decision-making, self-management, and communication, the design of the typical AVS is not optimized to communicate useful information in an understandable way. The AVS usability challenge is magnified in vulnerable patient populations such as those served by community health centers (CHCs). The purpose of this research was to evaluate and refine a redesigned AVS intended to better communicate information to CHC patients.
Agile Innovation to transform healthcare: innovating in complex adaptive systems is an everyday process, not a light bulb event
(BMJ, 2021) Holden, Richard J.; Boustani, Malaz A.; Azar, Jose; Medicine, School of Medicine
Innovation is essential to transform healthcare delivery systems, but in complex adaptive systems innovation is more than ‘light bulb events’ of inspired creativity. To achieve true innovation, organisations must adopt a disciplined, customer-centred process. We developed the process of Agile Innovation as an approach any complex adaptive organisation can adopt to achieve rapid, systematic, customer-centred development and testing of innovative interventions. Agile Innovation incorporates insights from design thinking, Agile project management, and complexity and behavioural sciences. It was refined through experiments in diverse healthcare organisations. The eight steps of Agile Innovation are: (1) confirm demand; (2) study the problem; (3) scan for solutions; (4) plan for evaluation and termination; (5) ideate and select; (6) run innovation development sprints; (7) validate solutions; and (8) package for launch. In addition to describing each of these steps, we discuss examples of and challenges to using Agile Innovation. We contend that once Agile Innovation is mastered, healthcare delivery organisations can habituate it as the go-to approach to projects, thus incorporating innovation into how things are done, rather than treating innovation as a light bulb event.
An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Beta Stage Usability Study
(JMIR, 2024-10-17) Mueller, Emily L.; Cochrane, Anneli R.; Campbell, Madison E.; Nikkhah, Sarah; Holden, Richard J.; Miller, Andrew D.; Pediatrics, School of Medicine
Background: Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. Objective: This study aims to engage caregivers of children with cancer in beta testing of a smartphone app for the medical management of children with cancer, assess acceptance, identify caregivers' perceptions and areas for improvement, and validate the app's design concepts and use cases. Methods: In this pilot, study caregivers of children with cancer used the Cope 360 mHealth app for 1 week, with the goal of daily logging. Demographics and a technology acceptance survey were obtained from each participant. Recorded semistructured interviews were transcribed and analyzed iteratively using NVivo (version 12, QSR International) and analyzed for information on usage, perceptions, and suggestions for improvement. Results: A total of 10 caregivers participated in beta testing, primarily women (n=8, 80%), married, with some college education, and non-Hispanic White (n=10, 100%). The majority of participants (n=7, 70%) had children with acute lymphocytic leukemia who were being treated with chemotherapy only (n=8, 80%). Overall, participants had a favorable opinion of Cope 360. Almost all participants (n=9, 90%) believed that using the app would improve their ability to manage their child's medical needs at home. All participants reported that Cope 360 was easy to use, and most would use the app if given the opportunity (n=8, 80%). These values indicate that the app had a high perceived ease of use with well-perceived usefulness and behavioral intention to use. Key topics for improvement were identified including items that were within the scope of change and others that were added to a future wish list. Changes that were made based on caregiver feedback included tracking or editing all oral and subcutaneous medications and the ability to change the time of a symptom tracked or medication administered if unable to do so immediately. Wish list items included adding a notes section, monitoring skin changes, weight and nutrition tracking, and mental health tracking. Conclusions: The Cope 360 app was well received by caregivers of children with cancer. Our validation testing suggests that the Cope 360 app is ready for testing in a randomized controlled trial to assess outcome improvements.
Best Practices for Health Informatician Involvement in Interprofessional Health Care Teams
(Thieme, 2018-01) Holden, Richard J.; Binkheder, Samar; Patel, Jay; Viernes, Sara Helene P.; BioHealth Informatics, School of Informatics and Computing
Academic and nonacademic health informatics (HI) professionals (informaticians) serve on interprofessional health care teams with other professionals, such as physicians, nurses, pharmacists, dentists, and nutritionists. Presently, we argue for investing greater attention to the role health informaticians play on interprofessional teams and the best practices to support this role.
Beyond Disease: Technologies for Health Promotion
(Sage, 2019-09) Holden, Richard J.; Valdez, Rupa S.; Medicine, School of Medicine
Health promotion is defined by the World Health Organization as “the process of enabling people to increase control over their health and its determinants, and thereby improve their health.” This is different from the bulk of formal healthcare processes, which are characterized by the treatment of an established disease. Much important human factors research and practice has been done to improve the healthcare delivery process and increasingly human factors professionals are also involved in work on health promotion. Such work has included examining the use and usability of wearable fitness tracking devices, studies of online health information seeking by healthy individuals, and human factors research on social robots for older adults, to name but a few examples. We discuss human factors applications in health promotion, focusing on examples from technology-related research.
Community-Based Service Providers’ Experiences With Activities for Persons With Dementia
(Sage, 2021-10) Holden, Richard J.; Cavalcanti, Luiz H.; Vemireddy, Sravani; Bateman, Daniel R.; Sheetz, Nicole; Fowler, Nicole R.; Parmar, Takshak; Karanam, Yamini L. P.; Medicine, School of Medicine
Persons with dementia (PWD) benefit from participating in meaningful activities. This study’s objective was to learn the characteristics of successful meaningful activities from community-based service providers who work with PWD. Six group interviews were performed with 15 unique professionals from an adult day service or community-based coordinated care program. These were supplemented by 100 hr of researcher immersion through weekly volunteering. Data were analyzed by a team, using qualitative content analysis. Participants reported successful activity content incorporated personalization; continuity and incremental challenges; and social engagement. Successful delivery of activities required managing necessary resources; involving informal (family/friend) caregivers; having a backup plan; monitoring time of day and energy levels; facilitating a domino effect; and ensuring safety. Outcomes of successful activities were experiencing fulfillment and purpose; overcoming challenges; and unexpected triggers. Research and practice recommendations include testing innovative, dynamic, and technology-enabled approaches to providing such activities.

Browsing by Author "Holden, Richard J."

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