The user experience was designed based on our years of exploration at the MIT Media Lab of the psychology of illness and the impact that technology could have on patient empowerment and patient-clinician collaboration. It is important to note that the CollaboRhythm application is different from typical electronic reminder applications. In fact, the application never alarms at patients, even if they forget to perform their health actions. Instead, the application focuses on providing awareness for proactive decision-making, self-reflection, and support from the coach.
Protocol Common to Control and Intervention Subjects
Following informed consent, a baseline blood pressure and heart rate were measured for each subject using the same automated sphygmomanometer. Weight was also measured and a hypertension knowledge assessment (a simple survey about normal blood pressures and the effects of diet, exercise, and medication that was created for the purpose of this study) was completed. The initial medication load was determined using the Medication Adjustment Plan as a reference and each dose step as a unit of 1. For example, if a subject was already on lisinopril 40 mg at the start of the study, the initial medication load was 2.
The nurse health coach conducted an introductory visit with each subject including motivational interviewing to assess their health values and to discuss
hypertension management goals. The subject and coach made shared decisions about diet, exercise, stress management, and medication. The same medication titration algorithm was used for both control and interventional
subjects.
At the conclusion of the study period, subjects in both groups returned for an exit visit. Blood pressure and heart rate were measured using the same automated sphygmomanometer that was used at the initial visit. Weight was measured using the same scale as the initial visit. A hypertension knowledge assessment was completed and an exit interview was conducted. The change in medication load was determined as well. For example, if a subject started the study on lisinopril 20 mg and ended the study on lisinopril 40 mg, the increase in medication load was 1.
Protocol Specifics for Intervention Subjects
The apprenticeship model of chronic disease management was discussed with the nurse health coach and with APF team prior to the study. It was also implicit in the design of the CollaboRhythm tablet application.
During the introduction visit, subjects in the inter-vention group received instructions from the nurse health coach on how to use the CollaboRhythm tablet application to self-track their medication adherence, to review progress using the charts, to propose or agree with changes in hypertension medications, and to communicate with messages.
Subjects in the intervention group received their hyper-tension care through the CollaboRhythm tablet application. All instant messages between the intervention subjects and the nurse health coach were automatically documented electronically. Other forms of communication were documented in a spreadsheet. During the exit visit, the tablet computer and the wireless blood pressure meter were returned.