Joint replacement patient care kits

By @ryantmcknight

Role: UI/UX design lead

In November of 2018, I traveled to Mt. Sinai Hospital in NY to participate in MIT’s “Hacking Medicine” hackathon.

Assigned to the “Mental and Public Health” track, I joined a team that sought to help US healthcare providers adjust to the new value based payment model. In particular, our team looked for ways to improve patient outcomes and reduce hospital readmissions. We wanted to both provide patients with a better quality of life and drive down costs to facilitate the effective management of value-based payment “bundles.”

The team organized around Dr. Duggal, an orthopedic surgeon who is experiencing the national shift from fee-for-service to value based care first-hand.

Dr. Duggal recommended we look for new opportunities in the pre and post-operative phases of care for joint replacement patients. These are the times when the provider has the least control over patient outcomes – when the patient is at home.

Identifying specific problems

To determine the best ways to improve outcomes and drive down costs, we mapped the current standard of care for joint replacement patients on a whiteboard wall.

  • What do current pre-op and post-op processes look like?
  • Who is involved on the provider side at each step?
  • What is the patient experience like at each step?
  • What are the specific problems that drive up cost?
  • Where might there be opportunities to intervene, upstream, and mitigate these issues?

During this exercise, we honed in on the top factors that negative impacted patient outcomes and were significant contributors to healthcare costs. At the top of our list were infections, rehab facility costs (the literature shows that home-based rehab is effective in improving outcomes for joint replacement patients), and a lack of patient knowledge about complications.

Drawing on Dr. Duggal’s personal experience and research on PubMed, we identified the following key issues with the current standard of care:

  1. ~1-3% of joint replacements become seriously infected, which significantly contributes to patient morbitity and drives up costs.
  2. A lack of patient understanding about complications contributes to unnecessary post-op tests and readmissions, further increasing cost.
  3. Rehab facility visits following a joint replacement are unlikely to improve patient outcomes but are expensive.

We also discovered that a number of hospitals have already attempted to address one or more of the problems we identified but that the solutions are highly fragmented and are often not available to providers in the community.

With a clearer understanding of the issues and opportunities, our team started to conceptualize a new service – direct-to-home pre and post-op care kits for knee replacement patients and a patient-facing app to guide the patients through the continuum of care.

Building the MedValue kit

For our final presentation, we decided to create a physical prototype of our kit and a few GIFs that displayed our app’s key functionality (I made these using Figma, InVision and GIPHY Capture).

The care kit we used during our pitch to the judges included the following items:

  • Alcohol-based soap
  • Bandages for proper wound care
  • Tapering schedule for opioids
  • Instructions for the management of pain without medication (e.g. clinically validated breathing techniques)
  • At-home rehab program printout and resistance bands

Although we only used a brief InVision demo during our pitch, our patient-facing app included the following:

  • Patient educational videos about what to expect during the post-op recovery process
  • At-home rehab videos
  • Remote wound care assessment via a smartphone camera
  • A way to contact a “care coordinator” about post-op complications

Note: To increase patient compliance, we also planned to use app notifications and text-based reminders.

Pitching to the judges

Below are the slides we used during our three minute pitch to the judges at the end of the weekend.