User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study (Preprint)

Abstract

BACKGROUND Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. OBJECTIVE This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, <i>Pathway</i> <i>Platform</i>, intended to enhance patient engagement, MBC, and SDM. METHODS Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. RESULTS In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the <i>Pathway app</i> while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the <i>Pathway app</i>. CONCLUSIONS Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the <i>Pathway Platform.</i> Key insights led to further development of the patient-facing and care team–facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey.

Design and Implementation of a Digitally Enabled Care Pathway to Improve Management of Depression in a Large Health Care System: Protocol for the Implementation of a Patient Care Platform

“…In addition, many mobile apps are only patient-facing and have not incorporated a care team interface, and the use of tracked content including symptoms and engagement with interventions in a single app is rare [ 10 ]. Creation of user-friendly mobile apps that incorporate user-centered design with input from patients with MDD and health care providers (HCPs) [ 11 ] can improve the development process, iteration speed, and implementation success, with the potential to improve patient outcomes in MDD [ 12 - 14 ].…”

“…Takeda Pharmaceuticals U.S.A., Inc., Lundbeck LLC, and Advocate Aurora Health (AAH) have partnered to cocreate a digitally enabled care experience with users (patients and care teams) and software developers, as well as health-tech product development specialists (Ctrl Group / Fora Health) to improve patient-provider engagement in the management and treatment of MDD. A digital mobile patient interface—the Pathway app —was designed with a conversational texting interface to allow patients to record daily mood symptoms, function, medication adherence, and side effects [ 11 ]. The Pathway app captures changes in a patient’s response to antidepressant pharmacotherapy and includes standard outcome measures, such as the 9-item Patient Health Questionnaire (PHQ-9) for depression [ 11 ].…”

“…A digital mobile patient interface—the Pathway app —was designed with a conversational texting interface to allow patients to record daily mood symptoms, function, medication adherence, and side effects [ 11 ]. The Pathway app captures changes in a patient’s response to antidepressant pharmacotherapy and includes standard outcome measures, such as the 9-item Patient Health Questionnaire (PHQ-9) for depression [ 11 ]. Patient interaction with the Pathway app allows for increased patient awareness of symptoms and overall functioning [ 11 ].…”

“…The Pathway app captures changes in a patient’s response to antidepressant pharmacotherapy and includes standard outcome measures, such as the 9-item Patient Health Questionnaire (PHQ-9) for depression [ 11 ]. Patient interaction with the Pathway app allows for increased patient awareness of symptoms and overall functioning [ 11 ]. Through the Pathway app , up-to-date information can be shared with the patient’s HCP to guide clinical discussions and enhance SDM between patients and their clinicians at routine visits as well as between visits, with the aim of optimizing individualized treatment plans and improving overall outcomes [ 11 ].…”

“…The user-centric approach created an opportunity for continued reassessment based on user feedback, faster iterations, optimized system performance, and sustainability. It also helped enhance the usability of the system, with the ultimate goal of improving treatment outcomes by supporting an expanded understanding of MDD treatment, assisting care team workflows, and providing people living with depression additional support throughout their treatment journey [ 11 ]. New features were included in the Pathway app that were not part of the pilot feasibility study, such as HCP visit preparation, patient education, and goal setting.…”