Using Beta-Version Mobile Health Technology for Team-Based Care Management to Support Stroke Prevention: A Qualitative Analysis
Date Submitted: Dec 5, 2016
Open Peer Review Period: Dec 7, 2016 - Feb 1, 2017
Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and assess the performance of the tools and impact on users. Using an open-source mobile platform, we developed a care management technology (CMT) for an intervention called Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) that is being tested in a randomized controlled trial. In the SUCCEED intervention, community health workers (CHWs) work collaboratively with care managers (CMs) in the health care system to empower recent stroke survivors to eat healthy foods, engage in physical activity, and use medications that can lower the risk of another stroke. The CMT was expected to facilitate achieving the target health outcome of reduced stroke risk by enhancing both the efficiency and effectiveness of the healthcare team. Objective: The primary objective was to describe the SUCCEED CMT and investigate CM and CHW perceptions of the CMT’s usefulness for team-based care management. Methods: We performed in-depth analysis of interviews conducted with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT’s ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT’s information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results: Overall, CMs and CHWs expressed that the CMT was useful. It helped them keep track of patient interactions and plan their work to ensure patients received the minimum set of interactions. The CMT guided CMs in developing care plans and allowed them to share the care plans with CHWs. For CHWs, the tool enabled electronic collection of clinical assessment data and provided decision support. It also tracked patients’ risk factor values and allowed CHWs to access these values in the field. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included the inability to link to educational materials outside of the platform or generate graphics of risk factor values over time, the extensive use of free-text responses, lengthy forms, and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet interfering with CHW-patient interactions. Conclusions: Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT’s effects on team performance.