Using Design Thinking to Create a Health System Wide Approach to Addressing Unmet Headache Access
Scott Friedenberg1, Apoorva Pradhan1, Rachel Dragano10, Peyton Latorre2, Mallory Sponenberg3, Adriene Zook4, Henry Aftewicz5, Leonard Learn5, Michael Stoppie6, Sandra Herr11, Jaime Kerestes7, Kimberly Mackes8, Joy Hill1, Raquel Martinez9, Jaime Silvagne6, Leann Webster4, Alyssa Callela1, Justin Kosman12, Eric Wright2
1Neurology, 2Pharmacy Innovation, 3Information Technology, 4Medical Therapy Disease Management, 5Retail Pharmacy Services, 6Health Information Technology, 7Pharmacy Services, 8Graduate Medical Education, 9Laboratory Medicine, Geisinger, 10Geisinger, 11Care Coordination Integration, Geisinger Health Plan, 12Geisinger Commonwealth School of Medicine
Objective:
To improve access to headache care by designing a population health-based model for prospectively capturing and managing headache patients.
Background:
Geisinger’s headache population far exceeds the bandwidth of our neurology department’s current access. A 12-month retrospective health plan survey identified 6987 poorly managed headaches patients defined as those over utilizing abortive medications (55%), neurology referrals with limited medication trials (24%) or having visited the ER twice within 6 months (22%). System-wide data showed that patients received a formal headache diagnosis, follow up visit or initiation of prescriptive medication less than half the time.
Design/Methods:
We partnered with headache patients, neurology, primary care, the ER, analytics, IT, pharmacy, insurance and administration for a human centered design thinking approach to expand our access. Using health system data and four 1-hour stakeholder empathy sessions, we developed a broader question, “How might we increase the access to headache knowledge in our system?” By balancing our population’s needs with already present health system resources, prototypes were developed and tested.
Results:
We developed a “Virtual Headache Hospital,” a novel space that combines technology and human capital to expand access and reduce barriers to headache care. We identify uncontrolled patients using EHR data. A multispecialty intake team assesses eligibility and facilitates transitions of care. PCP’s have real time, EHR-based fingertip access to diagnostic and therapeutic tools and a longitudinal headache specific report that provides a single screen summary of prior testing, consultation and treatments. Access to care was expanded by training 40 primary care embedded clinical pharmacists to manage headache, promoting electronic neurology consultations and implementing twenty-minute advanced practitioner neurology appointments.
Conclusions:
Using design thinking systemwide stakeholders developed opportunities for improved access for poorly managed headache patients. Next steps include iterative workflow improvements and developing clinical and resource utilization outcome dashboards.