Designing an Equitable Approach for Diagnosis and Treatment of Osteoarthritis in Primary Care Clinics.

Healthcare Design and Research | 2022-23 | Designed using Adobe Illustrator, Microsoft Excel, Miro | Role - Design Researcher

This project, a collaboration between Feinberg School of Medicine at Northwestern University and Tapestry 360, was carried out by Palak Shah and myself as design researchers, under the guidance and supervision of Andrew Berry and Nicholas Parades.

Osteoarthritis (OA) is a major cause of disability in the U.S., but effective treatments like exercise and education are not widely used. Disparities in OA care exist, especially in diagnosis and treatment among different racial and socioeconomic groups.

In this project, Tapestry 360, part of the AllianceChicago network, wanted us to focus on reducing OA pain and disability in knee and hip cases in primary care settings. By designing a care model using patient-centered design methods, which involved utilizing patient-reported outcomes (PROs) to assess knee and hip OA, we aimed to improve the diagnosis and treatment of OA, thereby addressing these disparities.

Methods

50

Hours of Secondary Research

16

Bilingual Patient Interviews and Journal Studies

6

Stakeholder Interviews

3

Iterations of the Prototypes

Skip to Concepts

Research

To thoroughly understand the current state of the project, we began with a swift secondary research phase. This initial step was crucial for grasping the existing disparities in Osteoarthritis (OA) care, as well as comprehending the involvement of primary care in arthritis treatment. Subsequently, we engaged in interviews with key project stakeholders who had prior experience in similar research topics. These discussions were instrumental in shaping our understanding of the project's scope, especially in terms of patient perspectives and the existing disparities.

Following this, we shifted our focus to direct interactions with patients. These patient interviews were essential for capturing the human-centered aspect of our research, allowing us to gain a deeper, more empathetic understanding of the patient perspective. This approach ensures that our project is not only informed by academic research and expert opinions but is also grounded in the real-life experiences of those most affected by OA.

Findings

In the interviews, our primary focus was on understanding patients' preferences for communicating with their care providers. We sought to uncover their expectations and the methods they preferred for tracking and sharing information about their pain. To gain deeper insights, we asked them to fill out a journal for a week, which provided us valuable feedback on their experiences with this method of tracking. These conversations revealed significant insights into the patients' desire to feel valued and heard in their healthcare journey.

Insights

From this exercise, we successfully mapped the journey of a patient with arthritis, ranging from the onset of initial symptoms to the ongoing management of the condition. It became evident that a patient's needs and expectations from their care provider vary significantly at different stages of their journey. Additionally, we were able to identify and delineate the specific needs of the patients for themselves and for their interaction with the care provider, creating a comprehensive understanding of the patient-care provider dynamic.

Through this process, we gained a deeper understanding of the patients' expectations. Initially, the project was focused on creating a digital method for collecting PROs. However, we soon realized that our intended audience preferred a non-digital approach. This insight led us to reframe the problem, focusing on developing a method that captures PROs in a more meaningful and appropriate way for our patients.

Problem Framing

From

How might we understand patients’ perspectives of pain to aid assessment of pain and functional limitation and design a method for digital PRO capture?

To

How might we capture Patient Reported Outcomes for Osteoarthritis in a way that is meaningful and considers all aspects of the patient's experience?

Concepts

Reframing the problem allowed us to design concepts aimed at enhancing the patient experience at various stages of their journey. Taking into account the insights and preferences expressed by the patients, we developed five distinct concepts that integrate PROs to track and enhance osteoarthritis care. These concepts, refined over three iterations, are set for further testing in the project's next phase.

Feedback

“This is wonderful and insightful. The interviews nail themes in the arthritis and communication literature but bring them to life with these quotes and themes. Kudos to the deep thoughtfulness and the effort to reach the new population. Each of these concepts has been thoroughly thought out and is backed by extensive research.” - Patricia D Franklin, MD, MPH, MBA, Feinberg School of Medicine

“This is fabulous. Am especially stuck by the thoughts on how the different expressions of pain from the patient perspective are incorporated” - Nita Mohanty, MD, Feinberg School of Medicine

“The calendar really stood out to me because of the colors. Because on the calendar I could see the days that my condition was worse or better, this and that. I could see the days when I experienced more pain.” - Osteoarthritis Patient, Phase 2 Participant

Next Steps

Portions of these concepts underwent testing during the project's second phase. The insights gathered from both phases are currently being compiled into an academic paper, which I am co-authoring with the team led by Andrew Berry.