Pain Addiction Progress 2009-11

From Clinicaltools.com

Contents 1 Project Guide 2 Overview 3 Progress During November 2009 by Objective 3.1 Objective 1 3.2 Objective 2 3.3 Objective 3 3.4 Objective 4 3.5 Objective 5 3.6 Objective 6 3.7 Objective 7 4 Work to be Performed in the Next Reporting Period 4.1 Objective 1 4.2 Objective 2 4.3 Objective 3 4.4 Objective 4 4.5 Objective 5 4.6 Objective 6 4.7 Objective 7 5 Contact 6 Appendix A 7 Other Progress Reports

Project Guide

SBIR Phase II Contract #HHSN271200900003C

ADB Contract No. N44-DA-9-2213

Title: Web Based Training for Pain Management Providers

PI: T. Bradley Tanner, MD

Monthly Progress Report #8

Reporting Period: 11/1/09 – 11/30/09

Project Period: 4/1/09 – 3/31/11

Pain and Addiction Project Framework

Overview

During November, we prepared for the 2nd usability test and continued to develop content for the project's website, PainandAddictionTreatment.com with guidance from expert consultants.

Progress During November 2009 by Objective

Objective 1

Develop Skills Training Content

Courses: We completed the first draft of the fourth course, Avoiding Diversion, and will send it to a consultant for review. We continued to integrate content on stage of addiction and pain condition into the four core courses. We started writing content for a case to illustrate the first core course. This case will be presented using the same format that we will use for the live SP cases.

"Key Info" Guides: We finished the content for the "Evidence" and "Guidelines" Key Info Guides and combined them into one guide, "Guidelines/Evidence", due to repeated content. It is ready to be sent for review by a consultant.

Objective 2

Build Supporting Functionality

• We continued development of two possible versions of the Standardized Patient chat interface and subjected them to informal internal review. Minor details were improved in preparation for the 2nd usability test. As part of the interface, we created a timer that counted up and could be started electively, a feature some potential users indicated they would like to have.
• We set up a sample case patient interface for the first core course, "Initial Assessment of Pain Patients." A completed case will be presented at the end of each core course to illustrated course content. The cases will be presented in a format the simulates the way cases will be presented in the live standardized patient courses.

Objective 3

Evaluate Curriculum Content

• We revised the first Course, Initial Assessment, according to feedback received from consultant Seddon Savage, MD. We were encouraged that her changes were mostly minor clarifications and additions. She volunteered that the overall website looked like it was going to be "very helpful."
• Course # 3: Ongoing management is still being evaluated by Steven Passik, PhD.

Objective 4

Evaluate Interface Design (Usability)

• We finished setting up and internally testing a remote, live standardized patient interface in preparation for usability test #2, which we will complete at the beginning of next month.
• We wrote and internally tested a usability script for testing of the remote, live standardized patient interface. A copy of the question portion of the script is attached as Appendix A.
• We recruited nurse practitioners in primary care or emergency departments for usability test #2 and scheduled 4 of them for the first week of December. We used a convenience method for recruitment; many participants had expressed interest during Phase I of this project.

Objective 5

Obtain OMB clearance

• We met with the project officer, Quandra Scutter, on OMB clearance by phone and discussed, via a series of email messages, the details of completing and sending the documents required for OMB clearance with her and the Ms. Genevieve deAlmeida-Morris, who will review the package before it goes to the NIH Clearance Office. The package, including SS-A, SS-B, Draft Data Collection Instruments, and the 30 and 60-day notices for the Federal Register, were ready for sending by the end of the month.

Objective 6

Conduct Summative Evaluation

• A draft of the Summative Evaluation data collection instruments was developed as part of the OMB package.

Objective 7

Disseminate Results

• We began development of a survey that will automatically be sent to completers of one of our training programs. It will inform them of the website and ask if they would like to be informed when the site is completed as well as whether they might have any interest in helping in the development phase. Those who express an interest in helping will be sent a brief needs analysis survey.

Work to be Performed in the Next Reporting Period

Objective 1

Develop Skills Training Content

• Revise core courses 3 and 4 as well as for the "Guidelines/Evidence" key info guide upon receipt of feedback from consultants.
• Continue to develop cases to illustrate the core courses
• Begin developing content for SP cases

Objective 2

Build Supporting Functionality

• Begin revising interface based on results of usability evaluation #2

Objective 3

Evaluate Curriculum Content

• Send core course #4, "Avoiding Diversion" and the "Guidelines/Evidence" key info guide for review by expert consultants

Objective 4

Evaluate Interface Design (Usability)

• Conduct usability evaluation #2 with 9 nurse practitioners
• Collate and analyze date from usability evaluation #2
• Develop action plans based on results from usability evaluation #2

Objective 5

Obtain OMB clearance

• Send completed package via Quandra Scudder to Genevieve deAlmeida-Morris who will review the package before it goes to the NIH Clearance Office.

Objective 6

Conduct Summative Evaluation

• No activity planned for this evaluation which will be conducted in summer of 2010.

Objective 7

Disseminate Results

• Finalize the needs analysis survey that will be sent to our customers who have expressed an interest in helping with the development of this project.

Contact

Please feel free to contact me if you have any questions or concerns. I can be reached at (919) 960-8118 or tanner at clinicaltools dot com.

T. Bradley Tanner, MD (President, Clinical Tools, Inc.)

Appendix A

Script for Usability Test #2

Regarding the webpage http://www.painandaddictiontreatment.com/Chad:

General

1. What are your initial impressions of this page?
2. Please comment on the layout of this page? (Do you like the appearance? The way it is organized? The content?)
3. What is the purpose of the tab on the left titled “Focus on Pain Conditions.” (What does this refer to?) (Is it obvious that the Chad interface fits into the “Focus on Pain Conditions” course?)

The tabbed interface

1. Please review the box with four tabs on top and a picture of Chad on the right. Without clicking, what do you think is found on each of these tabs? (If they don't get it right, advise them that this is the patient's medical record)
2. Please review the information displayed in the Case Intro tab. Please comment on the content provided. (Do you like the way it is presented? Organized? Is there anything you would add or take away?)
3. Please review the information displayed in the Medical History tab. (Do you like the way it is presented? Organized – is it ok that it is a long page and you have to scroll or would you prefer some of the history be presented on another tab? Do you like having the vital signs displayed here?) Is there anything you would add or take away?)
4. Please review the information displayed in the Medications tab. (Do you like the way it is presented? Organized? Would you prefer this information to be included in the Medical History page rather than on a separate tab?)
5. Please click on the laboratory tab and comment on it (Do you like the design? Content? Do you have any recommendations to improve it?)
6. Do you like the use of yellow highlighting to indicate an abnormal value? If not, what would be better?
7. Is the information displayed in the tabs appropriate for a standardized patient chat? Is there anything we should add to the patient's medical record?
8. Do you like having four tabs? Should there be more tabs or fewer?
9. How do you feel about the order of the tabs? Are there any that you would like to be displayed in a different order?

Clinical Actions

1. Please take a moment to review the Clinical Actions section of the page.
2. What do you think is the purpose of the Notepad? (Explain that it is for them to jot down their informal notes if they do not understand).
3. Please type something in the note pad. How do you think the information is saved?
4. How do you like this feature? (Would you use it? What would you use it for?)
5. Please review the Prescription Pad. What do you think is the purpose of this Prescription Pad? (Explain that this is where they could write their intended prescription for the patient if they do not understand).
6. How do you like this feature? (Would you use it?)
7. Do you feel we should include a drop down list of drugs and dosage, such as you might find in an electronic medical record?
8. Please review the Order Labs. What do you think is the purpose of Order Labs? (Explain that this is where they would order additional applicable labs if they do not understand). What do you think of its location under “Clinical Actions”?
9. Please locate the link “Write Clinical (“SOAP”) note. Where do you think this link would take you? (If they do not know, ask, “What would make this clearer?)
10. Please click on the link “Write Clinical (“SOAP”) note” now. What do you think is the purpose of this page?
11. How do you like this feature? (Would you use it?)
12. Would you add anything to the SOAP note page?
13. What do you think of our use of the acronym SOAP to organize this page. Are you instantly familiar with SOAP? Do you think other primary care physicians are?
14. Please close this page and return to the standardized chat interface page.
15. Is there anything you would change about/add to the Clinical Actions section?

The Timer

1. Please review the timer. How do you feel about having the optional opportunity to time yourself by clicking on this timer? How would you feel if it timed you automatically?
2. Do you like the placement of the timer? Would you move it to a different part of the page?
3. Would you like the timer to be visible at all times, or would you like the ability to set a goal of a specific time limit, for example 15 minutes, and then hide the timer, with prompts every several (say, five) minutes, and a warning when there is one minute left?

The Medical Library Please take a few moments to review the Medical Library section. We envision that this section would be used immediately before and after the live SP experience.

1. Please comment on the two sections of the Medical Library. (Is there anything you would add or take away? Please comment on the appearance. Organization.)
2. What do you think is meant by “Key Info Guides”? (Is it clear that this will take you to a resource?)
3. Please click on the “Medical Library” section. A box should open up with three links. Where do you think these links would take you? (Explain that they would be taken to the Courses and Key Info Guides on the PainandAddiction site if they are not clear).
4. How do you feel about the resources in the Medical Library section? Are there any links you would add or take away?
5. Please click the “Prescription Drug Monitoring” link. How do you feel about the planned use of this box?
6. How do you feel about the placement of the popup windows reviewed above? Where would be the preferred placement of the popup window be?
7. What is the preferred size of the popup window? (i.e. should they be smaller, etc.)

Now, please log in using the login information we sent you in the email. (tester1/tester1 etc)

Patient Chat Window

1. Please review and type something in the “Patient Chat Window” and click send. [Tester: Chat something back to the participant.] Please comment on the chat window (Size? Placement on the page? Being on the same page with patient case information which pushes the chat window down to the bottom of the page? What would you think of the chat window being next to the case information? )
2. This patient chat window will be used for the moderator, the standardized patient, and the interviewer to communicate. Do you like this method of communicating? Do you have any suggestions for improvement?
3. What would you think of having a button called “hats off” which would signify that the patient interview is temporarily suspended and you'd like to ask a question of the Standardized Patient on the process? We envision that clicking on the button would draw a line in the chat and enter the words “Hats Off” You would click the button again to re-start the patient interview. Would the words “Hats off” be clear enough of the purpose?

Now we are going to review an alternate patient chat interface. Please click the “Chad 2” link on the left hand navigational column. Please take a few moments to review this new interface page. Please click on the four tabs on the case patient information section.

Differences

1. Please click on the Medications and Labs tabs and note that you now would “Prescribe Medications” on the same tab as the list of current medications and you would “Order Labs” on the same “Labs” tabs where you find the lab reports. What do you think of this in comparison to having these two clinical steps separated out and on the right under a heading “Clinical Actions” as it was in the first interface we looked at? (Would you have expected to be able to order medications and labs here before you clicked?) Do you feel the same about each one (ordering medications and ordering labs?) (Which interface do you prefer?)

[Instruct them in how to go back and forth between the two versions if needed.]

Finish

1. What are your final thoughts about the two pages you reviewed today?
2. What advice can you give us as we develop this idea of SP experiences for PCPs?

Other Progress Reports