JMIR Publications

ABSTRACT

Background:

The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part due to Thailand’s “PD First” policy. PD is a home-based renal replacement therapy in which chronic kidney disease (CKD) patients perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in PD patients and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics including body weight, blood pressure, urine output, and ultrafiltration volume from each dialysis cycle and enter this information into a PD logbook. This information is reviewed at bimonthly PD clinic appointments. The CKD-PD app (Chronic Kidney Disease -Peritoneal Dialysis) app with NFC (Near Field Communication) and OCR (Optical Character Recognition) was developed to automate hydration metric collection. The information is displayed in the app for self-monitoring and uploaded to a database for real time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce morbidity and mortality related to overhydration.

Objective:

This study aims to identify usability issues and technology adoption barriers for CKD-PD app with NFC/OCR and monitoring system and use this information to make rapid cycle improvements.

Methods:

A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC/OCR and monitoring system. Participants were observed using the technology in their homes in 3 phases. Data collected include UTAUT questionnaire, “Think Aloud” observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app.

Results:

The CKD-PD app with NFC/OCR and monitoring system underwent three rapid improvement cycles. Issues were identified with the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation and display. NFC and OCR improved hydration metric capture but issues remained with their usability. The app stability and user interface issues were corrected, and hydration metrics successfully uploaded by the end of phase 3. Participants scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinic communication features.

Conclusions:

Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC/OCR and monitoring system. We believe this methodology can be accomplished with limited training in data collection, statistical analysis, and funding