3HP: IMPROVING ADHERENCE TO TB PREVENTATIVE TREATMENT
Recently, a 3-month (12-dose) regimen of weekly isoniazid and rifapentine (3HP) was recommended by the World Health Organization for the prevention of tuberculosis (TB) among people living with HIV (PLHIV) on common antiretroviral therapy regimens. However, the best approach to delivering 3HP to PLHIV remains uncertain. To study this research question, a 3-armed randomized trial was created where patients were either randomized to the Directly Observed Therapy (DOT) arm, the Self-Administered Therapy (SAT) arm, or a choice arm, where patients could choose DOT vs SAT using a shared decision making tool. DOT requires a weekly visit to the provider to receive their dose and be monitored for side effects; whereas SAT requires patients to make a weekly phone call to confirm their adherence, and visit only when refills are needed. We worked with Dr Adithya Cattamanchi's team to design a shared decision making aid to help patients choose their preferred method of treatment delivery: DOT or SAT, self-administered therapy. Additionally, we designed the experience for patients who were either randomized or chose the SAT treatment delivery option by designing a carrying case for their medication and the call-in experience.
Contact: Devika Patel
3M Surgical Clinic at Zuckerberg San Francisco General Hospital
This project aims to improve access, efficiency and experience for patients, providers and staff at a general surgery outpatient clinic at ZSFG.
Access: In our pre-COVID research, we used HCD interviews and predictive analytics to develop insights and opportunities for understanding the 30% no-show rate in clinic, and prototyped various transportation-related solutions to help patients overcome barriers to attendance. We are currently identifying insights and opportunities for designing a system of remote surgical care that can improve both access and efficiency of clinic visits, without compromising outcomes.
Efficiency: In our pre-COVID research, we found that patients often spend over 2 hours in clinic for a short outpatient visit. We used a combination of HCD and time-tracking observations to identify bottlenecks and pain points. Read more about our research here.
Experience: In our pre-COVID research, we used HCD interviews and architectural mapping techniques to develop insights and opportunities for understanding the patient experience in the waiting room. Read about our insights here.
Contact: Lara Chehab
COVID-19 Experiences
At the time of writing, over 78 million cases of COVID-19 have been documented worldwide. Of those, approximately 76 million people have recovered from the disease. In North America, nearly 19 million people have tested positive for the virus; yet, 18.5 million of those have recovered or are actively recovering from the disease. This project is a multi-centered design study that aims to understand the recovery experience of people who have been diagnosed with COVID-19 in North America. The goal of this study is to compare recovery experiences of hospitalized and non-hospitalized across San Francisco, Los Angeles, Michigan, Chicago and Toronto in order to inform recovery programs that can provide necessary and continued support to people during their recovery. Read about our learnings here.
Contact: Lara Chehab
End-of-Life Care for patients with advanced dementia
Over 5 million Americans with dementia are at risk for receiving high intensity and potentially unwanted and burdensome treatments - defined as mechanical ventilation, ICU admission, and resuscitation at the end of life. This project, led by PI and UCSF Hospitalist Liz Dzeng, investigates the systemic and cultural drivers of burdensome care among patients with advanced dementia near the end of life.
Contact: Lara Chehab
TuBerculosis Medication Adherence
Tuberculosis (TB) is the leading cause of infectious disease death worldwide. However, globally, treatment adherence is much lower than the WHO-recommended level of 90%. In Uganda, treatment adherence ranges from 60-75%. There is a unique need for a better way to track patient adherence and provide valuable care to patients. One such avenue is the use of digital adherence technologies, or technological tools that can help monitor patient adherence. We are working with Global Health Labs to design, prototype and test a novel TB medication adherence technology to help patients and providers monitor their treatment adherence. We are drawing upon insights from previous phases of research in working with redesigning 99DOTS (one such digital adherence technology) and working with TB preventive treatment for people living with HIV. Read about our insights here.
Contact: Devika Patel
VIRTUAL REALITY TRAINING PROGRAM TO IMPROVE TRAUMA CARE
Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there has been a shift to practicing skills through simulations with mannequins or patient actors. Virtual Reality (VR), and in particular, the use of 360-degree video and audio (cineVR), is the next-generation advance in medical simulation that has novel applications to augment clinical skill practice, empathy-building and team training. For this project, we focused on high-level trauma care at ZSFG. where out of approximately 255 trauma cases admitted each month, 90 are high-level “900 activations” that require speed and intense coordination across multiple departments.
We developed a training experience using cineVR and eye-tracking technology to help trainees in surgery, anesthesia and emergency medicine to experience a real and simulated 900 trauma activations from different perspectives, such as the charting nurse, the attending, and their fellow providers. Read about how we did it here.
Contact: Devika Patel
Medical Student Wellbeing
Medical student wellbeing is a critically important but understudied topic. We recently completed the largest survey of medical student wellbeing ever conducted. In addition to the survey, we conducted more than 20 in-depth interviews with medical students. Analysis of this data revealed that more than 50% of medical students meet criteria for severe distress, and 20% of all students surveyed have taken or considered taking a leave of absence for personal wellbeing. We also found that distress among medical students is exacerbated by multiple factors, including gender identity and debt burden. We are continuing to examine these associations to further understand the landscape of medical wellbeing. Through this work, we hope to identify coping mechanisms, habits, and characteristics of medical students which promote resilience and reduce distress. Our aim is to use this data to develop interventions which promote medical student wellbeing and reduce burnout. Read our study here.
Contact: Simone Langness and Nikhil Rajapuram
WRAP APP
Violence is an epidemic in our country. The Wraparound Project is a hospital-based violence intervention program at UCSF that works to reduce violent re-injury in San Francisco. This important work is largely achieved through the support and guidance of high-risk clients by dedicated and culturally competent case managers. Each client has a complex set of unique risk factors and psychosocial needs that require constant communication and follow-up with their case manager. We are collaborating with The Wraparound Project to create the Wrap App, a dedicated mobile platform intended to enhance communication and planning between case managers and clients to prevent the likelihood of future violent injury. Read about it here.
Contact: Devika Patel