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2019 HSR&D/QUERI National Conference Abstract

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4071 — Development, Testing, and Refinement of an Integrated Mobile Health Intervention for Veterans with CHF and/or COPD

Lead/Presenter: Erin Reilly,  COIN - Bedford/Boston
All Authors: Reilly ED (Social and Community Reintegration Research (SoCRR) Program, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA), Richardson LM (Center for Healthcare Organization and Implementation Research (CHOIR), , Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Purington P (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Wacks R (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA) Blok A (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA) Shimada SL (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA) McInnes DK (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA) Smith BM (Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines VA Hospital, Hines, IL; Center for Healthcare Studies, Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL) Hogan TP (Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; Division of Health Informatics and Implementation Science, Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA)

Objectives:
The transition from hospital to home is among the most vulnerable periods along the care trajectory. We report our process for developing a technology-assisted care transition intervention that leverages multiple technologies, including a virtual nurse guided tablet interaction and subsequent automated short message service (SMS) text messaging. The aligned technologies aim to educate Veterans with CHF and/or COPD about their care transition and self-management.

Methods:
We describe the development of our intervention across four interconnected processes. In Process I, intervention conceptualization, we consulted with clinical and behavior-change experts and conducted card-sorting exercises with Veterans to draft content. Process II, alpha testing, gathered feedback from 6 Veterans on usability and content. In Process III, beta testing, 12 Veterans with CHF and/or COPD tested the developed technologies. Process IV, implementation planning, included site visits and accompanying interviews across three VA facilities where the intervention was scheduled for evaluation in a randomized trial.

Results:
Each phase provided specific feedback and suggestions that resulted in iterative refinement. In alpha testing, Veterans found the virtual nurse compassionate, relatable, and knowledgeable, but suggested improved orientation to the intervention to help users anticipate the novel virtual-nurse tablet interaction. After further refinement, beta testing revealed continued improvement, with Veterans reporting the virtual nurse interaction as pleasant and easy (75%) and no texting usability difficulties (80%). Implementation planning interviews guided additional development of supplemental materials for patients, text-message content, and dissemination.

Implications:
We highlight processes and results related to conceptualizing, testing, and iterative revision of a care-transition intervention. Our process and accompanying results demonstrate that effective usability and content feedback, built across multiple processes, is essential for a successful end-product intervention that provides mobile-care assistance while integrating into existing clinical settings.

Impacts:
The result was a highly usable tool that is being tested as part of an intervention in a three-site randomized controlled trial. Based on our process, we present a generalized development, testing, and implementation planning model that can be used to guide development of future technology-assisted interventions.