Betta Owens

CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved

This paper reviews the research and development around a consumer health informatics system CHESS (The Comprehensive Health Enhancement Support System) developed and tested by the Center for Health Systems Research and Analysis at the University of Wisconsin. The review places particular emphasis on what has been found with regard to the acceptance and use of such systems by high risk and underserved groups.

Empowering patients using computer based health support systems.

With the increased pressure to contain healthcare costs, it is critical to find more eVective ways of providing information, emotional support, decision making, and behaviour change assistance for patients. In the United States, a doctor spends approximately 18 minutes in face to face contact with the patient during each clinic appointment. 1 During morning hospital rounds, physicians spend on average just over four minutes in the patient’s room. 2 It has been proposed that ideal physician communication with patients with breast cancer should be tailored to patients’ needs or coping styles to reduce their distress. 3 However, in an environment of continued pressure to reduce healthcare costs, it is virtually impossible for doctors to give patients adequate information or even direct them to appropriate support resources. If costs are to be reduced while at the same time improving patient support we must find new ways to help patients to cope with their disease, make necessary decisions, and gain emotional support. Computer systems can help to fill this void. A key problem encountered by people facing a health crisis is that they are often given information when they are least able to take it in, such as at the time of diagnosis. SiminoV and others have concluded that nearly all studies point to serious gaps in patient recall and understanding of the information they are given. 34

CHESS (Comprehensive Health Enhancement Support System): an interactive computer system for women with breast cancer piloted with an underserved population.

The Comprehensive Health Enhancement Support System (CHESS) Is an Interactive computer system containing information, social support, and problem-solving tools. It was developed with Intensive input from potential users through needs-assessment surveys and field testing. CHESS had previously been used by women in the middle and upper socioeconomic classes with high school and college education. This article reports on the results of a pilot study Involving eight African-American women with breast cancer from impoverished neighborhoods in Chicago. CHESS was very well received; was extensively used; and produced feelings of acceptance, motivation, understanding, and relief.

Computerized information and support for patients with breast cancer or HIV infection.

Abstract In a randomized trial, a computer program was made available to patients with breast cancer or HIV infection. This article focuses on patient concerns over time and their use of the computer program.

Women–Focused Treatment Agencies and Process Improvement: Strategies to Increase Client Engagement

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement.

Development and Test of a Model to Predict Adherence to a Medical Regimen

Objective: To develop a predictive model that projects patient adherence to new and existing medication regimens. Methods: A panel of adherence experts was convened to develop a decision theoretic model to predict and explain patient medication adherence behavior. Two predictive models were developed: one for patients new to their regimen and one for patients on an existing regimen. The models have 12 and 13 predictive factors of adherence, respectively. The panel developed levels for each factor and diagnostic value estimates for each level. Results: Both models were tested by having randomly generated hypothetical patient medication adherence profiles scored by the model developers and a separate panel of healthcare practitioners. These scores were then compared with predictions made by the model. For the new-to-regimen model, the correlations were 0.86 for the development panel and 0.68 for the healthcare practitioner panel. Only the practitioner panel scored the existing medication model. The models correlation with their scores was 0.88. Conclusions: The medication adherence model seems to have promise as an approach to predicting the likelihood of medication adherence. The model has the benefit of considering many factors of adherence simultaneously. It can also highlight areas that may result in patient nonadherence and suggest potential intervention strategies to enhance patient adherence to a medication regimen.

Reducing errors of omission in chronic disease management

The inability to successfully transition patients from one level of care into another is a persistent flaw of most chronic disease management systems (Gandhi, 2005; Laurence et al., 2004). A central component of chronic disease management is to move patients along the continuum of care so the disease can be managed over time, particularly following an acute episode. When patients become disengaged in the continuum of care, they often become disengaged in chronic disease management, leading to unnecessary acute episodes (George, 1996). This health care phenomenon originates from isolated health delivery system components that are organized by traditional treatment functions and rarely coordinated. This discontinuous flow of services often forces patients to build their own bridges within the continuum of care. All too often patients fail to successfully bridge these cracks, and errors of omission occur. Errors of commission occur when individuals or organizations ‘do the wrong thing’. This is characterized in medication errors or conducting surgery on the wrong leg. Not as well publicized, but equally harmful, are errors of omission. Omission errors are ‘not doing the right thing’, for example, clinical staff not ensuring that an addiction treatment patient discharged from inpatient care moves directly to an outpatient program to receive adequate care in order to prevent relapse. These errors of omission place the patient at risk. Morbidity, mortality, health care and other societal costs can be reduced by ‘doing the right thing’—designing chronic disease management systems to facilitate successful patient transitions between levels of care.

Use of an Interactive Health Communication Application in a Patient Education Center

Abstract This pilot study sought to determine whether it was feasible to offer an Interactive Health Communication (IHC) application in a Patient Education Center (the Center) or patient library setting, if patients would be satisfied with the IHC, and whether the Center exposure would result in home use. Four disease-specific modules were available on a computer in the Center, and in-home access was offered. Patients who continued the IHC use at home were mailed a survey approximately eight weeks later. Use data were collected. Staff time and response was used to determine feasibility. Sixty-one percent of the patients introduced to the IHC chose to use it; of those, 87% chose to use it at home. This report clearly shows that patients valued the intervention and the impact on staff time was minimal.