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dmi:Design Value Award Winner - Live Well Collaborative
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dmi:Design Value Award Winner




Live Well Collaborative - ADL 1-2-3 Team and Cincinnati Children’s Hospital Medical Center

Innovating Outcomes for Pediatric Bone Marrow Transplant Patients


Cincinnati Children’s Hospital Medical Center (CCHMC) is one of the most highly ranked children’s hospitals in the world, with their cancer program, the Cancer and Blood Diseases Institute (CBDI), receiving special recognition for their patient experience. Each year, CBDI cares for about 6,780 children and young adults, and CCHMC is known for providing innovative care to pediatric and young adult patients with rare, relapsed, and difficult-to-treat cancers.

One of CBDI’s most compelling case studies is in their work to reduce the risk of Bloodstream Infections (BSIs) in pediatric Bone Marrow Transplant (BMT) patients. Patients receiving radiation and chemotherapy for cancer, or when undergoing BMT, are at an increased risk of BSIs due to treatment related immunocompromise. BSIs are a significant problem in CBDI patient populations, leading to prolonged hospitalizations, intensive care admissions, extensive antibiotic treatments, increased mortality, and increased cost of care. 

Fortunately, research has shown that there are a few simple activities that cancer patients can do to reduce BSI rates. Called Activities of Daily Living (ADL), these include: 1) bathing with chlorhexidine gluconate (CHG) once per day; 2) getting out of bed and being active at least twice per day; and 3) practicing oral care three times per day, as prescribed by a doctor. 

An existing educational initiative and adherence program called ADL 1-2-3 is aimed to teach cancer patients about the importance of ADL and encourage adherence to the protocol. Inspired by reports that use of a token economy motivates patients and improves adherence, CBDI developed a paper-based system where clinical staff managed a weekly sticker chart in the patient’s room to track completion of ADL 1-2-3 tasks. Based on their adherence to the program, patients were then given play money that could be exchanged for prizes.

Patient adherence immediately improved from 25% to 66%. However, managing the sticker charts, and the system overall, increased the burden on clinical care staff’s already limited time. Clinical staff have many high-priority demands in care delivery as a result of the acuity and complexity of these patient populations, so the results were challenging to sustain. While conducting observational research, an interdisciplinary team of design and engineering students from the Live Well Collaborative, a non-profit co-founded in 2007 by the University of Cincinnati and Procter & Gamble as an academic-industry driven innovation center, noted the challenges of the paper-based system. They hypothesized that an automated, digital-based solution could help reduce workload burdens on the clinical staff and improve adherence by empowering patients to manage their own daily infection prevention activities. 

Following their initial observations, the Live Well team conducted additional research to gain further insights into clinical staff workflows, environmental limitations, and patient conditions. Their research suggested that, with an automated system, administrative requirements of the ADL 1-2-3 program could be minimized, data could be easily logged and seamlessly archived for future learnings, feedback delays could be shortened, and paper items could be replaced with digital points. 

The Live Well team investigated ways to automate the point collection process, with the goal to enhance patient and family engagement in completing daily tasks through an interactive incentivized program. The team utilized Live Well’s design driven process model to conduct stakeholder research and to better understand the challenges and project scope in its entirety, which inspired their ideation phase in which sketches and renderings were transformed into 3D concepts through rapid prototyping. They then developed an interactive device that allowed maximum freedom for all users, while taking into account the constraints of current hospital protocols. 

The CCHMC team and their patients have found significant value in using the ADL 1-2-3 device. 

  • The workload burdens of nursing staff have been significantly decreased with use of the automated system.
  • Patient adherence is greatly improved resulting in reduced infection rates and improved cost of healthcare.
  • Families and those connected to the patient receive a sense of empowerment in their care.
  • The system has positively influenced the overall atmosphere of the patient journey, from the perspective of both the clinician and the patient/caregiver, creating positive organizational and cultural change.

Because of these positive results, an additional 24 devices are currently being tested through a randomized trial at CCHMC’s base campus. Outcomes continue to be favorable and, in fact, a second iteration of the project is currently being executed at the Live Well. The ADL 1-2-3 device is an excellent example of utilizing design thinking methodologies to create impact, encourage positive change, and substantiate value in the development of life-changing solutions.

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