User-centered design of a longitudinal care plan for children with medical complexity

• Published in: Journal of the American Medical Informatics Association : JAMIA Vol. 27; no. 12; pp. 1860 - 1870
• Main Authors: Desai, Arti D, Wang, Grace, Wignall, Julia, Kinard, Dylan, Singh, Vidhi, Adams, Sherri, Pratt, Wanda
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 09.12.2020
• Subjects: Caregivers; Child; Chronic Disease - therapy; Electronic Health Records; Health Personnel; Humans; Legal Guardians; Parents; Patient Care Planning; Pediatrics; Research and Applications; User-Centered Design; User-Computer Interface; user-computer interface; patient care planning; chronic disease; pediatrics; hospital medicine; health information exchange; patient portals; care coordination; transitional care
• ISSN: 1527-974X; 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocaa193

Abstract Objective To determine the content priorities and design preferences for a longitudinal care plan (LCP) among caregivers and healthcare providers who care for children with medical complexity (CMC) in acute care settings. Materials and Methods We conducted iterative one-on-one design sessions with CMC caregivers (ie, parents/legal guardians) and providers from 5 groups: complex care, primary care, subspecialists, emergency care, and care coordinators. Audio-recorded sessions included content categorization activities, drawing exercises, and scenario-based testing of an electronic LCP prototype. We applied inductive content analysis of session materials to elicit content priorities and design preferences between sessions. Analysis informed iterative prototype revisions. Results We conducted 30 design sessions (10 with caregivers, 20 with providers). Caregivers expressed high within-group variability in their content priorities compared to provider groups. Emergency providers had the most unique content priorities among clinicians. We identified 6 key design preferences: a familiar yet customizable layout, a problem-based organization schema, linked content between sections, a table layout for most sections, a balance between unstructured and structured data fields, and use of family-centered terminology. Discussion Findings from this study will inform enhancements of electronic health record-embedded LCPs and the development of new LCP tools and applications. The design preferences we identified provide a framework for optimizing integration of family and provider content priorities while maintaining a user-tailored experience. Conclusion Health information platforms that incorporate these design preferences into electronic LCPs will help meet the information needs of caregivers and providers caring for CMC in acute care settings.