MSKI Patient Reported Outcomes
Musculoskeletal Institute: UT Health Austin
Jacob Rader, Jose Colucci, Matt Love
Design Institute for Health
A Different Approach to Musculoskeletal Care
The Musculoskeletal Institute MSKI at the UTHA (University of Texas Health Austin) is a forward thinking clinical practice utilizing an Integrated Practice Unit (IPU) care team structure. Each IPU care team includes a diverse team of experts. They ask, and listen to, patient preferences and incorporate those into shared decision-making, provide personalized risk/benefit analyses across the journey. The care team tracks pain and functional outcomes before, during, and after appointments, and adjust care plans as needed. MSKI is also working towards Value-Based Care.
Analyzing Processes and Exploring Opportunities
To understand the MSKI's structure, processes, systems, and we spent the first 2 months of this project interviewed people from a diverse range of specialties at the MSKI and referencing organizational documents, presentations,
Process map of a daily functioning of the Musculoskeletal Institute created through reviewing organizational documents and conducting primaries interviews with the individuals involved in the operation of the to help surface problems in the system and operation.
The joint MSKI + Design Institute team chose four priority areas: the MSKI brand, the scheduling process, relationships with outside providers, and PROs (Patient Reported Outcomes). After careful consideration by MSKI PROs were selected as the main priority area to move forward to prototyping with.
Patient Reported Outcomes
What are PROs and why are they important?
Patient Reported Outcomes (PROs) are legacy surveys that clinicians distribute to patients in the clinic and after their care to set health baselines and measure outcomes.
What is the challenge with current PROs?
PROs are repetitive and technical surveys. These documents, never designed for patients, don't engender a high level of engagement, especially post-care. Every single clinic at UT Health Austin uses a different set of PROs. This reflects the needs of their clinics; it also creates a lot of redundancy and confusion for patients.
Dozens of Concepts, 4 Key Moments
Working with the MSKI team, we developed dozens of concepts to improve the delivery of PROs. To explore these concepts, we developed, deployed, and tested working prototypes with actual patients in MSKI’s Clinic at UT Health Austin.
Unifying the PRO Experience
We had twos goals in our redesign, first was to standardize the structure, second was to unify the visual language.
Other Patient Engagement Strategies
In Clinic Testing
4 Key Moments for Patient Engagement
These prototypes reflected 4 key moments in the patient journey primed for improving engagement.
1. On Their Way In
As a patient, your experience begins not when you enter the clinic but at home; most doctors now ask you to fill-out forms ahead of time. This paperwork is often lengthy, repetitive, and clinically inclined. This includes PROs.
Our first priority was to improve that experience for patients. By creating a better, patient-centric design around PROs, we hoped to encourage a higher level of engagement before, during, and after care.
To test, we created a redesigned survey for select patients at MSKI’s clinic. When patients arrived for their appointment, we offered them the opportunity to try out our new version.
2. In the Clinic
Once in the clinic, we wanted to explore how education could help patients better understand their role in this new Value-Based Care model and the importance of their engagement with PROs.
To test this, we placed educational posters in each MSKI exam room explaining what Value-Based Care is, how it’s different from what they’re used to, and the importance of PROs in that care.
To evaluate the impact of our posters, we asked each participant what, if anything, they learned about value-based care in their post-visit interview.
3. On Their Way Out
As patients exit the clinic, we want to reinforce that their care does not end when they leave. As part of our prototyping, we created several behavioral nudges designed to help patients buy into this journey:
Asking patients for permission to send their follow-up PROs via text message.
Incentivizing patients to complete their post-care PROs with a $10 donation to a charity of their choice.
Providing patients reminder cards with the charity they selected and the date they’ll receive their PROs.
4. At Home
Every in-clinic intervention we created was designed to shape a better experience for patients and develop their understanding of PROs so that when they’re home, they might have a better chance at completing these critical follow-ups.
As part of our prototyping, a week after their visit, patients received a second set of interventions:
A postcard mailed to patients highlighting the charity they selected and a QR code linking them to their PROs.
A text message with a friendly note and link to complete their PROs.
To Be Continued...
The outcomes of this work led to longer term, longitudinal studies that will inform MSKI's practices.