September 9, 2014

Amy Ranier, Director, Patient Experience Communications,

UPMC

Todd Pollock, Quality Manager, Donald D. Wolff Jr. Center for

Quality, Safety & Innovation at UPMC

Gamification as a Means to

Manage Chronic Disease

• A world-renowned health care provider and insurer

based in Pittsburgh that strives to invent new

models of accountable, cost-effective, patient-

centered care

• The largest non-governmental employer in

Pennsylvania, with more than 62,000 employees

• A nonprofit that melds an unwavering community

mission with entrepreneurial business models

Who is UPMC?

2

• More than 20 academic, community, and specialty

hospitals and 400 outpatient sites; employs more than

3,500 physicians; offers an array of rehabilitation,

retirement, and long-term care facilities

– More than 264,000 inpatient admissions and observation

cases

– More than 3.6 million outpatient visits

– Nearly 650,000 emergency visits

– Nearly 174,000 surgeries

– More than 500,000 home care visits

Who is UPMC?

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Until recently, UPMC’s patient education was decentralized,

resulting in lack of clear direction and consistency for patients.

Mission

• Prepare patients and health plan members for safe passage

throughout the health care continuum

• Improve health outcomes through education and self-

management strategies

Patient Education and Engagement at UPMC

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Vision

• Transform the current system of providing patient education

into a more comprehensive systemwide approach throughout

UPMC.

• Engage patients, their families, UPMC Health Plan members,

and our health care professionals.

With support by parallel efforts such as The Beckwith Institute,

we are exploring ways to better engage patients through shared

decision making and new approaches to encourage patients and

their families to take control of their health.

Patient Education and Engagement at UPMC

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No more time!

No more staff!

No more money!

Future of Health Care

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Simplification of Heart Failure Education Content

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Created a

snapshot

one-pager of

“Just the

Facts”

Reduced HF

education

book from 41

pages to 16

pages

• What if we converted “Just the Facts” to a

platform that would engage patients and

get them to focus on 3 critical survival

skills?

1. Medication Compliance

2. Daily Weighing and Reporting Symptoms

3. Schedule and Attend Follow-up Physician Appointment

within 7 days of discharge (inpatient)

if symptoms occur (outpatient)

Simplification: What If…?

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• What if we took the techniques that have

proved successful in adult learning and

applied them to heart failure?

• What if we took the principals of gaming

and used them to make learning about

heart failure easier and fun?

Simplification: What If…?

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• Complex Patients

• Readmission Risk

– Nearly 25% of patients hospitalized with heart failure are

readmitted within 30 days

– An analysis of Medicare claims data from 2007 to 2009

found that 35% of those readmissions within 30 days

were for HF

• Behavior Change is Key

Source: Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure, Feltner, et al; Annals of Internal Medicine

Volume 160, June 30, 2014

Why Tackle Heart Failure?

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Goal

Through patient education, influence

patient knowledge and behavior to reduce

heart failure readmissions during the first

30 days after discharge.

Why Tackle Heart Failure?

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• Etcetera Edutainment (EE) is the leader in delivering

video games that drive learning and behavior change.

• January 2005 spinout of Carnegie Mellon University

– Internationally renowned for combining game development +

learning + design + engineering

• EE’s platform, simcoach® is a framework for delivering

game-based products for assessment, teaching,

practice, and ongoing coaching of critical behaviors

– simcoach® products focus on a few key skills that will have the

biggest impact on a measurable outcome.

Meet Etcetera Edutainment…

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simcoach® Platform in Other Industries

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simcoach® platform leverages qualities of games proven to

facilitate learning and motivate behavior change:

1. Goals

2. Active Participation

3. Consequences

4. Feedback

Why Video Gaming?

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• Active Focus

– Player (patient) must make choices to proceed through the game (material)

– Choices have consequences/ immediate feedback

– “Doing,” not watching – we know this is how adults learn best

• Critical Skills

– Limited to a few critical behaviors that we want to drive in to cement habits

– Show their choices’ impact on health outcomes and also that there are skills

they can apply right away towards a healthy lifestyle/outcomes.

– Patient education is often overwhelming, with long lists of dos/don’ts

• Consistency

– Traditional patient education delivered by clinicians who are diverse in their

comfort as educators

Using Gaming Principles vs. Traditional Patient Education

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• Patients (Research, Play Testing)

• Cardiologists

• Pharmacists

• Unit Directors

• Staff Nurses

• UPMC Patient Experience Communications

• UPMC Center for Quality Improvement and

Innovation

• Etcetera Edutainment

The Original Pilot Team

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• Interviewed and observed CHF patients:

– Confusion… "I'm still in the dark." "It's gone by

in a blur."

• Weighing vs. weight loss

– Denial…"I just need to be at home."

– Powerlessness… “Ain’t nothing you can do.

Just take your meds and hope.”

The Approach

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• Weekly meetings

• Play testing!

• Pilot rollout at one unit in one hospital

• Refine, expand, refine

The Approach

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UPMC eHealth Coach Demo (Version 1.0)

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What Our Patients and Nurses Told Us – Notes from Initial Pilot

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Loved the

program!

(Patient, 92)

Patient felt it was useful

and liked it; would like to

be able to get app at

home. (Nurse)

Useful! Played

it until I got it

right! (Patient)

A good teaching tool

to discuss with

patient. Patient stated

it was an "excellent"

tool. (Nurse)

Initial Pilot Results – UPMC Mercy Hospital

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Knowledge

Testing:

Patient Group

No Change in

Test Results

Improved

Knowledge

Pre-Pilot (n=21) 13 8

Pilot

(n=20) 5 15

Survival Skill

Compliance:

Patient Group

Checking Weight

Daily Taking Meds

Follow-up MD

Appt Attended

All Mercy HF

Patients (n=85) 61% 82% 78%

Pilot

(n=10) 90% 100% 80%

1* Patient Readmitted from Pilot Group vs. None from Pre-Pilot

Initial Pilot: One Hospital, One Unit

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• Patients are interested and engaged

• Families are participating

• Nurses love it

• Sustainable

• Scalable to other diseases/conditions

Results – Why This is Worth Continuing

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• Simplify setup to improve workflow for nurses

• Adjust for deployment in both inpatient and

outpatient settings

• Make Simon a character, separate from player

• Evolve interaction to be dialogue between

player and Simon

Version 2.0 – What’s New

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Version 2.0 Demo

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• iOS (iPad and iPad Mini)

• Windows (Surface Pro 3)

• Android (Tablet)

• Web

Version 2.0 – Devices/Platforms

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Todd Pollock

Manager, Center for Quality Improvement & Innovation

pollocktp@upmc.edu

412-802-8077

Amy Ranier

Director, Patient Experience Communications

ranierak@upmc.edu

412-647-1396

Thank You!

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