UPMC is 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. This presentation describes a pilot program UPMC has initiated to leverage gamification as a means to manage chronic heart failure.

1. 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

2. • 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?
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3. • 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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4. 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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5. 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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6. No more time!
No more staff!
No more money!
Future of Health Care
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7. 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

8. • 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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9. • 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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10. • 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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11. 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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12. • 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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13. simcoach® Platform in Other Industries
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14. 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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15. • 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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16. • 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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17. • 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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18. • Weekly meetings
• Play testing!
• Pilot rollout at one unit in one hospital
• Refine, expand, refine
The Approach
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19. UPMC eHealth Coach Demo (Version 1.0)
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20. 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)

21. 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

22. Initial Pilot: One Hospital, One Unit
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23. • 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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24. • 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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25. Version 2.0 Demo
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26. • iOS (iPad and iPad Mini)
• Windows (Surface Pro 3)
• Android (Tablet)
• Web
Version 2.0 – Devices/Platforms
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27. 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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