JMIR Publications

ABSTRACT

Background:

Clinical practice guidelines recommend antiplatelet and statin therapies, blood pressure control and cessation of tobacco products for atherosclerotic cardiovascular disease (ASCVD) patients. However, these strategies for risk modification are underused by patients with ASCVD, especially in rural communities. The needs of and resources available to rural patients with cardiovascular disease are different than their urban/suburban counterparts, requiring a distinct approach to their care. Interventions developed without considering the unique needs of rural populations often fail. Approaches tailored to this population are needed.

Objective:

Using a Participatory Design (PD) approach, a multidisciplinary team sought to develop a sociotechnical intervention to enable rural primary care teams to systematically improve the cardiovascular health of patients with ASCVD. The intervention included adapting an existing technology for delivery of expert guideline recommendations into clinical practice in rural communities.

Methods:

Development took place in four stages: I) Initial Understanding, II) Ideation and Experimentation, III) Prototyping the Intervention, and IV) Designing the Sociotechnical System. Our team observed clinical encounters, interviewed patients, and conducted workshops with rural care team members to develop viable intervention concepts. We then iteratively prototyped in a routine clinical practice and refined a pilotable version of the intervention with extensive stakeholder feedback.

Results:

The sociotechnical intervention was created with input from clinical team members (n=35) in Austin and Adams, Minnesota. This collaboration resulted in contextually-grounded workflows and a clinical decision support tool that [1] identifies patients with ASCVD who would benefit from additional care touchpoints, [2] aggregates crucial medical information for clinical decision-making, and [3] assigns the appropriate care team role to determine care plans. The resulting intervention enables care teams to systematically, collaboratively, and proactively deliver care for patients with ASCVD.

Conclusions:

The PD process was invaluable in developing a cardiovascular intervention that establishes a sociotechnical system comprised of novel responsibilities, workflows, and technology while acknowledging capacities and limitations of rural health care clinics. Next steps involve the evaluation of the intervention impact on standard metrics of quality cardiovascular care and the dissemination of the intervention to other clinic locations while maintaining core values of human-centered design.