UX/UI Case Study: Reducing Hospital Readmission Rates for Eating Disorders

The document below presents an ideal UX approach, where extensive research, user interviews, the creation of detailed user stories, wireframes, and prototypes, as well as thorough user testing, would be essential. This approach allows for a deep understanding of the users and their problems, leading to a highly informed design.

However, this level of effort may not always be feasible in the real world due to time and resource constraints. Therefore, while this document outlines a comprehensive process ideal for any UX project, a more practical recommendation would be to implement the necessary components selectively, applying them as needed to address the most critical user needs at each stage of the project.

Table of Contents

• What’s the problem?
• What’s the business?
• Personas, Problem Scenarios, and Propositions
  • Charlene the Therapist
  • Amy the Client
• Customer Interview Guide
• What problem are we solving? For who?
• Value Hypotheses & Testing
  • What is the customer journey?
  • Testing
  • What are the key assumptions/hypotheses?
• Experiment Design (Customer Motivation & Engagement)
  • Client Communication and Access to Data
• User Stories & Prototypes
• Business Model Design (how do we test our user interface)
• Appendix A: Customer Discovery Notes
• Appendix B: Usability Testing
• Appendix C: Chain of Relevance Check-In

What’s the problem?

It is estimated that eight million Americans have an eating disorder; seven million women, and one million men. Eating disorders have the highest mortality rate of any mental illness. The National Association of Anorexia Nervosa and Associated Disorders reports that 5-10% of anorexics will die within 10 years of contracting the disease; 18-20% will be dead after 20 years, and only 30-40% fully recover. The mortality rate for anorexia in women is 12 times higher than the death rate for ALL causes of death for females 15-24 years old. After suicide, the primary causes of death for women with eating disorders is related to cardiac involvement.¹

Around 80% of women who have accessed care for their eating disorders are discharged weeks before the recommended stay. The cost of outpatient treatment, including therapy and medical monitoring, can extend to $100,000 or more. Only one in 10 people with eating disorders receive treatment. The average cost for a month of inpatient treatment is $30,000. It is estimated that individuals with eating disorders need anywhere from 3-6 months of inpatient care. Rates of minorities with eating disorders are similar to those of white women.1

Hospital costs have reached over $41.3 billion for patients readmitted within 30 days of discharge. For Medicaid patients, the three conditions with the largest number of 30-day all-cause readmissions were mood disorders, schizophrenia, and diabetes.

For privately insured, the three conditions with the largest number of 30-day all-cause readmissions were maintenance chemotherapy, mood disorders, and complications of surgical or medical care. Readmission rates are 17.2% for 65+, 14.6% for 18-64 on Medicaid, 8.7% for 18-64 Privately Insured, and 10.6% for uninsured. For mood disorders, specifically for Medicaid, the readmission rate is 19.8%, 10.4% for Privately Insured, and 12.7% for uninsured.²

What’s the Business?

For [mental health professionals] who [provide counseling services for eating disorders], the [Hospital Readmission Reduction Application] is a [software application] that [reminds these professionals about follow-ups and provides guided paths to effectively follow up, including outpatient resources]. Unlike [current market products], our product [also monitors for readmissions to immediately put that client on the healthcare professional’s radar to help minimize their subsequent stays and medical costs].

Personas, Problem Scenarios, and Propositions

Note that there would normally be several Personas created for this type of application. This example will focus on two Personas.

Charlene the Therapist

Screening Question: Do you regularly provide mental health services that either require hospital admission or as a follow-up to hospital admission for eating disorder-related mood disorders? Save

Charlene has been working as a therapist for over 20 years in the St. Louis, MO area, she focuses on BDD and eating disorders. She grew up with a mother who was very concerned with her daughters being thin, which caused her sisters to develop an eating disorder. Charlene watched as her older sister grew up with this disease, and she saw the negative impact it had on her family. As a result, Charlene does everything she can to stay healthy, she works out 3-5x a week at her building’s gym, she goes on morning runs around her suburban neighborhood. While she has no children of her own, she keeps up on child psychology issues as she’s learned that they tend to bleed into teenage and early 20s years and have a great deal of impact on eating disorders in adults. Charlene treats over 20 regular patients and provides in-patient services on-call for the hospital. She likes to avoid hospitalization for her clients as much as possible, but when it is necessary she has found that it is difficult to keep up with follow-up; and she is often dismayed to find out that a client has been admitted to the hospital without any notification by the hospital or client.

Charlene is technologically savvy but has found that performing administrative work takes up a considerable amount of time. For every hour she spends with a client she spends around an hour filling out notes and paperwork. This means that she works a lot of unintentional overtime as she really wants to provide her clients with the time they need, even if that means she stays late. She has a receptionist, but her receptionist is specifically for administrative work and not for any clinical work.

Amy the Client

Screening Question: Do you currently receive therapy for an eating disorder?

Amy is 17 years old and was diagnosed with an eating disorder when she was 11 years old. She is the middle child with an older sister and younger brother. She attends high school and was held back a grade due to low performance in grade 10. Her mother suffered from an undiagnosed eating disorder and through counseling she and Amy realized that she was putting her own insecurities onto Amy. Amy has been in counseling with Charlene for six years since her first hospitalization. She felt she was released too early and was quickly readmitted after relapsing.

Amy enjoys playing soccer and going out with her friends. She likes comedies and thriller movies. She likes to read books about vampires and magic. She has dreams of becoming a doctor when she grows up. Amy works hard to stay on track and follow the plan Charlene has outlined for her but she feels like she’s just one of many in Charlene’s client list and feels ignored when she can’t get an answer until her next session. She feels like she can’t talk to her mom because her mom is part of the problem.

Amy is very technologically savvy and likes to use SnapChat, Instagram, Facebook, WhatsApp, and because she likes to make jewelry she likes to see what other people have done on Pinterest.

Customer Interview Guide

Screener

Do you regularly provide mental health services that either require hospital admission or as a follow-up to hospital admission for an eating disorder
related mood disorders?

Persona Hypothesis

• Tell me about [yourself in the role of the persona]?
  Tell me about being a therapist? Why did you choose to become a therapist? What do you like most about the job? What do you like least? What are the hardest parts of your job? What are the easiest?
• Tell me about [your area of interest]?
  Tell me about your current process when you get a new client. Tell me about the process you follow when called to the hospital to see a new client. Who all is involved in the intake of one of your clients? How do they communicate with you? How do you communicate with your clients?
• Tell me your thoughts about [area]?
  How are things done now vs. how would they work in a perfect world? What have you seen work well vs not well for following up with clients after hospital admission? What contributed to the best outcome you’ve experienced? What contributed to the worst outcome you’ve experienced?
• What do you see in [area]?
  Where do you learn what’s new in mood disorders and treatment? What do others do? Who do you think is treating mood disorders most effectively? What programs do you know of that are doing the best job with mood disorders?
• How do you feel about [area]?
  What do you feel about hospital practices regarding eating disorder discharge policies? What motivates you? What parts of providing therapy are most rewarding? Why? How do you feel you can do better for your clients?
• What do you do in [area]?
  What do you do in your practice to help prevent hospital readmittance? What do you do to keep in contact with your clients? How many hours did you work last week? Is that typical? What are your favorite online tools to use? What are your favorite resources to give to your clients?

Problem Hypothesis

• What are the top [5] hardest things about [area of interest]?
  What are the top 5 hardest things about providing therapy? Why? What are the top 5 hardest things about providing care at the hospital? Why?
• What’s [difficult, annoying] about [area of interest]?
  What’s difficult about providing therapy? What’s difficult about following up with your clients? What makes it difficult to communicate with your clients after therapy? What annoys you about the current process at the hospital for intake and discharge?
• How do you currently [operate in area of interest]?
  How do you currently communicate with your clients between sessions? How do you currently share information with the friends and family for how they can support their loved one? How do you communicate with the hospital about your clients and how do they communicate with you? Who communicates with you?
• What are the top 5 things you want to do better this year in [general area of interest]?
  What are the top 5 things you want to do better this year for your clients in your practice? What are the top 5 things you want to do better this year for your practice at the hospital?
• Why is/isn’t [your specific area of interest on that list]?
  Why isn’t [X] on that list?

Closing and Miscellaneous

• Casting a Line (“Anything else?”)
• Housekeeping and Follow-up

What problem are we solving? For who?

What job are we doing for who? How do we know if it’s working?

‘A certain therapist exists, and she needs to lower her clients’ hospital readmission rate. Currently, she tries to keep up with her clients during her off hours, but if we offer her a program that will utilize the information from her sessions to recommend a follow-up schedule and resources, and that will enable her to keep an open line of communication with her clients, then we’ll observe a lower hospital readmission rate for her clients, and fewer fines for the hospital on readmissions for their clients.

Value Hypotheses and Testing

What is the core value hypothesis?

If we provide therapists with a tool for communication with the hospitals and their clients, then they will try it, buy it, standardize on it, and it will improve hospital readmission rates and client outcomes with therapy.

What is the customer journey?

Comparables

Note that this section is incomplete for this demo purpose but would be helpful for an actual product.

TherapyNotes – Therapynotes.com

• Schedule appointments within or allow clients to schedule appointments.
• Document session with easy to use templates and to do lists.
• Create bills and submit insurance claims.

TheraNest – theranest.com

• Easily create notes, progress notes, initial assessments, treatment plans.
• Sign, approve, and co-sign notes.
• Integrated with common HER applications and planner applications.
• Automatic templates for notes.

SimplePractice – simplepractice.com

• Access to notes, scheduling, and billing in one application.
• Fully paperless client intake.
• Send secure, HIPAA-compliant messages to/from clients.
• Schedule appointments easily with online booking.
• Lets clients upload documents.

Prototypes

Concept 1 (therapist view on iPad, client view on iPhone)

Note: this is a single quick mockup for this example, an actual project would contain several mockups and wireframes for all aspects. This is an idea of the type of wireframes that could be provided.

We could move to higher fidelity wireframes for a clickable prototype. (this is just an example of a health app, not necessarily this app)

Business Model Design (How do we test our UI?)

Key Partners
– Therapists
– Hospital IT
– Hospital Nurses
– Clients
– Input of client data.
– Sharing of client data between hospital and therapist.
– Sharing resources and data from therapist to client and vice versa.
– Client feedback to therapist.

Key Activities
– Searchable notes with keywords and associated resources.
– Resource feedback.
– Chat / forum capability for therapist and client.

Value Propositions
– Ability to be notified immediately of a hospital readmission.
– Ability to communicate quickly and effectively with clients in a means that works for them.
– Ability to share appropriate resources with clients. Ability to receive feedback on resources.
– Ability to search notes by both therapist and client.

Customer Relationships
– Therapist to Hospital
– Hospital to Therapist
– Therapist to Client
– Client to Therapist

Customer Segments
– Therapists
– Clients
– Hospitals
– Insurance Companies

Key Resources
– Client data from therapists
– Client data from hospitals
– Client input from client
– Resource data from therapists and clients

Channels
Digital applications available on computer and all forms of mobile device (indicates a web app approach).

Cost Structure
– Research, Design, and Development.
– Server, database, and hosting.
– Ongoing maintenance.
– Application integration with EHRs and CRMs.

Revenue Streams
– Lower hospital readmission rates = fewer fines for therapists and hospitals.
– Based on research therapists would be willing to pay up to $X per month per client.

Appendix A – Customer Discovery Notes

Visit Charlene’s Office on March 3, 2020

• Audience: Charlene T.
• Venue/Circumstance: 1234 Main Street, Suite 202, 63108
• Notes on the Persona: [What was on their A-list? What were they like? Think-See-Feel-Do?]
• Notes on Problem Scenarios: [Which ones did they have? What alternatives? What value propositions might resonate?]
• Insights on Personas and Problem Scenarios: [How did the interview prove or disprove key hypotheses on your personas and problem scenarios? How else did they change your point of view?]
• Other Insights: [add notes]

Note: This would be repeated for each custom discovery.

Appendix B – Usability Testing

Charlene Therapist – Exploratory Testing

Objectives and Methods: Therapist should be able to add a new patient (or import from EHR), schedule a recurring appointment with a specific number of recurrences, be able to add private and shared notes to a client’s record, select resources to share with the client, add a new resources, map resources to the client’s preferred address, view chat requests from the client, respond to chat requests, view ratings on resources by the client, perform admin capabilities (summarized for brevity).

Product Version: Version 001.01

Subjects: Charlene T. – Therapist – See Personas

Pre-Session Checklist

• Therapist account active: username and password sent to therapist.
• Therapist data imported: Confirm with therapist that data import was successful.
• Prototype able to achieve all activities above (these would normally be broken into individual test items): Confirm by walking through test plan.

Session Design

This is where a full explanation of the software would go with its benefits and an outline of the features it contains. This would include a walk through tutorial of  how to use the software in the most basic terms (potentially have the client watch a video so the experience is consistent from therapist to therapist and client
to client).

Footnotes

1. South Carolina Department of Mental Health. (n.d.) Retrieved from https://www.state.sc.us/dmh/anorexia/statistics.htm
2. Hines, A. L., Barrett, M., Jiang, H. J., Steiner, C.A. (2014, April). Statistical Brief #172. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf