I enjoy working with clinicans, administrators, patients, and families to improve the care experience. I also enjoy collecting and analyzing clinical data from healthcare claims databases, electornic medical records, and publically reported databases to understand challenges and areas of improvement with current care delivery.
Improving Care Transitions for Older Adults
Overview
Care transitions are some of the most vulnerable times for older adult patients and their families. This is especially true when older adults are being transferred from the hospital to another level of care, often with new diagnoses and care routines. Over my professional and academic career, I have worked to improve the clincial handoffs and involvement of patient and families in care cooridnation. Below are two examples of recent projects that I have led in this area.
Example Project 1: Evaluating the Effectiveness of PHRs for Home Health Encounters
I used the Home Health Value Based Purchasing Dataset and longitudinal interviews from patients and caregivers to evaluate how PHRs could improve care delivery during home health services following a hospitalization.
Methods/Skills: Interviews (individual and group), instrument development and administration, R, RedCap
Example Project 2: Managing the University of Chicago Medicine 30-Day Readmission Reduction Program
I led several projects to reduce the 30-day readmission rate on key patient populations at the University of Chicago Medicine. One project specifically looked at the care transition from UCM to skilled nursing facilities. Our team enacted several procedures to improve care coordination and handoff between the facilities. These procedures included sign off from the geriatric medicine team before discharge, ensuring continuity of pain management plans and medication availability prior to transfer, and clincial process improvements to reduce night and weekend transfers.
Methods/skills: Clinical workflow and data analysis, project management, meeting facilitation, and Lean Healthcare techniques
Related Publications
- Kneale, L. The Unviersity of Chicago Medicine’s Readmission Reduction Program. Joint Commission Reosurces National Pacing Event, Chicago, Illinois, 1 April 2013.
- Kneale, L. The Unviersty of Chicago Medicine’s Readmission Reduction Program. Joint Commission Resources All National Hospital A.D.E. and Readmissions Event, Chicago, Illinois, 4 March 2013.
Promoting Effective Self Care Routines
Overview
More older adults are living independently and the burden of performing self care routines often fall on the older adults themselves or their caregivers. Technology can play an important role in assisting older adults with completing these activities
Example Project 1: MobilePT
I partnered with a smart-home application manufacturer to test the feasbility and effectiveness of an application designed to support at-home physical therapy routines with older adults who were at high risk for falls.
Methods/Skills: Semi-structured interviews, patient/self-care workflow analysis, contextual interviews
Example Project 2: Usability of PHRs for Home Health
I have led two projects that examined the usability of personal health records (PHRs) for older adults who receive home health services. The first evaluated whether existing PHRs would be able to accept, manage, and share data related to home health visits. In the second study, I created scenarios and personas to evaluate the usability of PHRs from multiple persepctives- a homebound older adult, an adult caregiver, and a home health nurse.
Methods/skills: Creating personas, designing usability scenarios, heuristic evaluation and expert review.
Related Publications
- Kneale, L., Chauduri, S., Rosenberg, D., Zampino, L., Weiler, A., Demiris, G., Phelan, E. Smart-Phone Application Evaluation for Older Adutls Prescribed Physical Therapy for Fall Prevention. Poster session presented at: 21st IAGG World Congress of Gerontology and Geriatrics. 24 July 2017; San Francisco, CA.
- Kneale, L., Choi, Y., Mikles, S., Thompson, H., Demiris, G. Evaluating Publically Available Personal Health Records for Home Health. Paper presented at the National Library of Medicine Training Conference. 27-28 June 2016; Columbus, Oh.
- Kneale, L., Choi, Y., Demiris, G. Assessing commercially available personal health records for home health: recommendations for design. Applied Clincial Informatics. 2016 May 18; 7(2): 355-367.
- Kneale L., Mikles S, Choi YK., Thompson, H., Demiris, G. Using Scenarios and Personas of Older Adults and their Care Team to Enhance the Effectiveness of a Heuristic Evaluation. Journal of Biomedical Informatics. 2017 September; 73:43-50.
Discovering Older Adult Technology Preferences for Healthcare
Overview
Research suggests that older adults adopt technology for different reasons that other adult populations. Although more older adults are using technology, little is understood about how this population wants to use technology for healthcare activities. Understanding older adult preferences can help ensure that products designed for older adult users meet the expectations and may be adopted by this population.
Example Project #1: Fall Detection Devices
Older adults were asked about their opinions and preferences of fall dection devices in a series of focus groups. I participated in the analysis of these transcripts, and the synthesis of the results.
Methods/Skills: Focus groups, qualitative analysis
Example Project 2: Robotic Technology Applications for Healthcare
Adults of all ages were asked to complete a paper survey that included the Negative Attitudes Toward Robots Scale (NARS). Responses were stratified by age group, and a comparison of perceptions between younger and older adults was conducted.
Methods/skills: Survey recruitment and administration, quantitaive analysis
Related Publications
- Backonja U., Hall AK., Painter I., Kneale L., Lazar A., Cakmak M., Thompson H., Demiris G. Comfort and attitudes towards robots among young, middle-aged, and older adults: a cross-sectional study. Journal of Nursing Scholarship. 2018 September 19.
- Kneale, L., Choi, Y., Mikles, S., Thompson, H., Demiris, G. Evaluating Publically Available Personal Health Records for Home Health. Paper presented at the National Library of Medicine Training Conference. 27-28 June 2016; Columbus, Oh.
- Kneale, L., Choi, Y., Demiris, G. Assessing commercially available personal health records for home health: recommendations for design. Applied Clincial Informatics. 2016 May 18; 7(2): 355-367.
- Kneale L., Mikles S, Choi YK., Thompson, H., Demiris, G. Using Scenarios and Personas of Older Adults and their Care Team to Enhance the Effectiveness of a Heuristic Evaluation. Journal of Biomedical Informatics. 2017 September; 73:43-50.