背景:COVID-19大流行迫使数字健康工具的传播,以解决用于慢性健康管理的有限临床资源。它还照亮了需要非正式护理人员(IC)来获得这种护理的老年患者群体,技术素养,或英语水平问题。对于心力衰竭(HF)患者,这种快速转变加剧了对IC的需求,并推动加拿大人走向患者和IC合并护理的二元护理模式。我们以前的工作确定了一个机会,通过一个二元数字健康的共享模型来改善这种二元HF体验。我们称这种替代护理模式为“Medly的照顾,“它使IC能够同时扩大患者的自我护理能力,同时承认IC渴望提供更大的支持。
目的:我们介绍了Medly二元管理模块Caretown的系统设计和开发。虽然HF是概述的用例,我们概述了我们的设计方法,并报告了6个核心疾病不变特征,这些特征应用于HF管理的二元共享护理。这项工作为将来对CaretownforMedly的可用性评估奠定了基础。
方法:我们进行了定性,以人为中心的设计研究,基于25次半结构化访谈,对患有HF的亲人的自我识别IC进行访谈。访谈由2位编码人员独立进行主题内容分析,以演绎方式得出(例如,根据面试指南)和归纳提炼。为Medly建立Caretown模型,我们(1)利用知识行动(KTA)框架将知识转化为行动,(2)借用GoogleSprint的快速解决大问题和测试新想法的能力,“这在医疗和数字健康领域是有效的。具体来说,我们将这两个概念融合到一个名为“KTASprint”的新框架中。“
结果:我们确定了6个核心疾病不变特征,以支持护理二元组合中的IC,以提供更有效的护理,同时利用二元护理的协同优势。功能设计为可定制性,以适应患者的病情,通过利益相关者分析,有文献证实,并通过用户需求评估进行审查。这些功能包括(1)实时报告,以增强数据共享并促进适当的IC支持,(2)护理卡加强对护理指导的作用,(3)直接消息传递,以解决整个护理圈的脱节,(4)药物钱包,以改善管理复杂药物治疗方案的指导,(5)医疗事件时间表,以改善和巩固管理和组织,和(6)护理人员资源,以提供针对疾病的教育并支持他们的自我保健。
结论:这些疾病不变特征旨在满足IC在支持其护理伙伴方面的需求。我们预计,这些功能的实施将通过数字健康为慢性病管理提供共享的护理模式,并将改善护理二元组的结果。
The COVID-19 pandemic forced the spread of digital health tools to address limited clinical resources for chronic health management. It also illuminated a population of older patients requiring an informal caregiver (IC) to access this care due to accessibility, technological literacy, or English proficiency concerns. For patients with heart failure (HF), this rapid transition exacerbated the demand on ICs and pushed Canadians toward a dyadic care model where patients and ICs comanage care. Our previous work identified an opportunity to improve this dyadic HF experience through a shared model of dyadic digital health. We call this alternative model of care \"Caretown for Medly,\" which empowers ICs to concurrently expand patients\' self-care abilities while acknowledging ICs\' eagerness to provide greater support.
We present the systematic design and development of the Caretown for Medly dyadic management module. While HF is the outlined use case, we outline our design methodology and report on 6 core disease-invariant features applied to dyadic shared care for HF management. This work lays the foundation for future usability assessments of Caretown for Medly.
We conducted a qualitative, human-centered design study based on 25 semistructured interviews with self-identified ICs of loved ones living with HF. Interviews underwent thematic content analysis by 2 coders independently for themes derived deductively (eg, based on the interview guide) and inductively refined. To build the Caretown for Medly model, we (1) leveraged the Knowledge to Action (KTA) framework to translate knowledge into action and (2) borrowed Google Sprint\'s ability to quickly \"solve big problems and test new ideas,\" which has been effective in the medical and digital health spaces. Specifically, we blended these 2 concepts into a new framework called the \"KTA Sprint.\"
We identified 6 core disease-invariant features to support ICs in care dyads to provide more effective care while capitalizing on dyadic care\'s synergistic benefits. Features were designed for customizability to suit the patient\'s condition, informed by stakeholder analysis, corroborated with literature, and vetted through user needs assessments. These features include (1) live reports to enhance data sharing and facilitate appropriate IC support, (2) care cards to enhance guidance on the caregiving role, (3) direct messaging to dissolve the disconnect across the circle of care, (4) medication wallet to improve guidance on managing complex medication regimens, (5) medical events timeline to improve and consolidate management and organization, and (6) caregiver resources to provide disease-specific education and support their self-care.
These disease-invariant features were designed to address ICs\' needs in supporting their care partner. We anticipate that the implementation of these features will empower a shared model of care for chronic disease management through digital health and will improve outcomes for care dyads.