Perspective

Personalization by Design: Just Do It

hannah hamlin, angela Devanney, tony Digioia, mD

The current health care landscape is rapidly changing – patients increasingly care about personalization and convenience in their care. The 2019 NRC Healthcare Consumer Trends Report shared that over 50% of patients make health care related decisions based on convenient, easy access and 80% would switch providers for convenience alone (NRC Health, 2019). These metrics will only continue to increase following the COVID-19 pandemic. Few patients make health care decisions based on factors such as expertise or quality alone. Providers are now challenged to redesign how they provide high quality, expert care in a way that is convenient and meets the preferences of patients.

Knowing Patient Preferences

Patients’ wants and needs must be understood to meet patient preferences. Nine times out of ten, what care team members think a patient prefers, differs significantly from their actual wants and needs. This requires the care team (all roles in the health care delivery team) to ask and listen to patients, what services interest them, and how they want to receive care. Once these preferences are known, providing highly customized and personalized services can be co-produced. Asking patients to share their preferences is not difficult. The Bone and Joint Center at UPMC Magee-Womens Hospital has utilized the “What Matters to You?” tool, patient shadowing, and workflow analysis to identify and meet patient needs, while delivering leading clinical outcomes. Patient engagement tools like these actively involve patients in their care and are proven to make substantial improvement on outcomes for any intervention. These tools, paired with conversation-oriented questions, are applicable in any care setting and meant to engage the patient real-time and deliver human-centered care.

The Bone and Joint Centered deployed this tool in 2020 and 2021 to partner with patients and re-design their patient education pathway so that patients were better prepared and could go home sooner. Simple questions included: ● What types of exercise would you like to learn how to do? What do you enjoy doing now? ● Describe the type of information that you would like to know about hip and knee arthritis, prevention, non-operative treatment, and a total joint replacement if needed. ● Rank how you would prefer to be presented information, 1 being most preferred and 5 being least preferred.

Data revealed that patients desired comprehensive and highly coordinated care, mobility-increasing and cardiovascular exercises they could do at home, and written stepwise education delivered verbally and electronically (that could be shared with their coach). Not surprisingly, patients had specific interest in services related to weight loss, pain management, exercise, and smoking cessation.

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Patients also indicated that they still prefer a traditional physical paper copy for education materials, but are also interested in education delivered through a website or app. These preferences, when paired with the additional services that interested patients, served as an opportunity for the care team to redesign an education and care pathway that reflected patient preferences. Interestingly, the care team was asked for their perception of how patients would respond; they were surprised that patients’ preferences and responses differed so greatly from theirs.

Honoring Patient Preference

Using high-impact, low-effort coproduction tools has led to innovation, development of customized services, and pathways that honor preference. The Bone and Joint Center has used “What Matters to You?” data to ideate and implement four programs in the recent years– showing that it is possible to deepen person-centered care and innovation during a pandemic.

Ranked Preference Modality of Education

1

2

3

4

5 Paper Copy

Website/App

Visual Images

In-Person Conversation

Other

Move to Mobility

The AMD3 Foundation developed the Move to Mobility education series to provide web-based video demonstrations of pre- and post- surgical rehabilitation exercises. Not only does this program provide education in a dynamic way, it meets patient requests to impact weight loss and exercise for people with varying levels of osteoarthritis - two topics in which patients were most interested. The stepwise video series serves as a platform for patients to do safe and effective exercises at home prior to their total joint replacement. Patients can move through each video with the guidance of a physical therapist, right in their home for free. This platform also allows patients to absorb information at their own pace and includes questions, tips, and tricks from actual patients. Center for Bone and Joint Health

The Center emerged as a direct result of asking “What Matters to You?” as it became evident that patients desired preventative approaches to maintain bone and joint wellness, not just curative treatments. The Center is based out of the Bone and Joint Center at UPMC Magee-Women’s Hospital and serves highly complex patients in a personalized way. The first cohort of patients at the Center had an average of 10 comorbidities each, most likely a result of the siloed health care system and worsening medical conditions due to the delay of treatment during the COVID-19 pandemic.

The Center has served as a connector of services for its patients, using motivational interviewing and

questions that embody the ethos of “What Matters to You?” to keep patients’ preferences, goals, and voices at the center of care for any provider. The Center has quickly become central to patients needing to navigate the health care system, leading to partnerships with clinical programs such as the Midlife Center, the Osteoporosis Center, pain management services, and Western Wellness.

Screening Tools for Osteoporosis and Literacy in Musculoskeletal Problems (LiMP)

The Center has also led to the emergence of two new screening tools to align patients’ desire for early intervention and clinical services.

Through iterative use of questions like “What matters to you?” in the Center for Bone and Joint Health, patients identified the need for osteoporosis care, specifically a screening tool. This resulted in the implementation of a screening and treatment pathway for patients identified as having or at high-risk for osteopenia or osteoporosis. While new, the screening tools and pathway will help to avoid fragility fractures among high-risk patients.

Additionally, both the Center for Bone and Joint Health and the Bone and Joint Center recognized a need to measure health literacy among their patients. Musculoskeletal patients with lower proficiencies in health literacy experience worse outcomes and have decreased satisfaction than their counterparts following a total knee arthroplasty (Narayanan et al., 2021). Both practices began screening patients for LiMP and found that 63% of all patients had a normal score but 37% had a low score. This confirmed that the care team needed to deliver information that patients want (weight loss, pain management, weight loss, smoking cessation) in the way they want, (print and digital) in a way that is easy to comprehend, and in plain terms. The team now evaluates their education and other patient-facing materials to make sure they meet adult learning principles and are written with health literacy in mind to ensure equitable care (and outcomes) are being delivered.

Meeting the Needs of Patients in the New Normal

Health care providers and systems must work to ensure that they are aware of patient preference and do what they can to honor those preferences. Using “What Matters to You?” and other similarly inquisitive questions as the primary patient engagement tools to amplify patient voices have been instrumental to meet patient needs at the Bone and Joint Center and, in general, for middleaged patients wanting to maximize their bone and joint wellness and overall health.

References:

Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med. (2012 Mar 1);366(9):780-1. https://www.ncbi.nlm.nih.gov/ pubmed/?term=22375967 NRC Health. (2019). 2019 Healthcare Consumer Trends Report. https:// nrchealth.com/wp-content/ uploads/2018/12/2019-HealthcareConsumer-Trends-Report.pdf Narayanan, A. S., Stoll, K. E., Pratson, L. F., Lin, F. C., Olcott, C. W., & Del Gaizo, D. J. (2021). Musculoskeletal Health Literacy is Associated With Outcome and Satisfaction of Total Knee Arthroplasty. The Journal of arthroplasty, 36(7S), S192–S197. https://doi.org/10.1016/j. arth.2021.02.075

Ms. Hamlin is a Project Consultant at goShadow and a 2023 MHA candidate at The Ohio State University.

Angela Devanney is a founding member of goShadow, a technology startup focused on person-centered care, process mapping, and improvement. Angela is an expert advisor and speaker in safety and reliability, improvement science, valuebased care, customer experience, employee engagement, and retention. Her background combines extensive clinical and operations experience alongside consulting and service delivery for clients in the public and private sector of all sizes domestic and abroad. Angela provides practical, relationship-focused expertise to process improvement and implementation support for leaders and teams using experiential learning techniques and human-centered tools.

Dr. DiGioia is medical director of the Bone and Joint Center at UPMC Magee-Womens Hospital and comedical director of the Center for Bone and Joint Health.