Using community and technology to improve access to care for heart failure patients in an underserved urban neighborhood in Houston, Texas

Objectives and theoretical framework: The objective of this research is to present the results of a usability study of ubiquitous computing and biosensors in a medically underserved neighborhood. The ultimate goal of the project is to create a system of care that combines easy-to-use inexpensive biosensors with personal support by promotoras (community health workers) in an effort to improve access to health care and quality of life for heart failure patients. Previous research has found that 50% of heart failure hospitalizations are preventable and that primary health care based on episodic physician office-based management is inadequate to meet the needs of heart failure patients particularly those in medically underserved communities. The theoretical framework for this study recognizes that health failure treatment requires continuous monitoring that cannot be provided in a doctor's office; management of a patient's disease must occur where they live, work, and play. This is especially true in areas where poverty, social isolation, and access to care issues exacerbate already existing barriers to health care. Methods: We conducted a usability study of the system of biosensors, ubiquitous computing, and culturally appropriate support in stable heart failure patients in the medically underserved, Hispanic community of Pecan Park, Houston, Texas. Since 2005, we have partnered with the community to increase access to health information and health care. The ongoing project to monitor cardiac output and connect heart-failure patients with culturally appropriate support and real-time feedback combines community-based interventions with a free wireless “cloud” and inexpensive biosensors. In this study, quantitative and qualitative data on the usability of the biosensor device were analyzed using data generated by the device, survey methods, and observation. These data included the type and number of errors, time required for use, accuracy success for individual readings, overall performance, and acceptability and comfort for patients. Major findings: Preliminary findings reveal that among a medically-underserved, all-Hispanic population promotora-supported wireless technology such as biosensors is a viable approach to managing heart disease. Based on the results of this study, modifications were made to the device, including a bigger, color display; a simpler interface; and clearer indications of function. Conclusions: Improving access to care for heart failure patients requires tools for self-management, face-to-face culturally competent support, and understandable and reliable real-time health information. This study provides evidence that the use of technology-enabled interventions is a viable method for supporting self-management of heart failure in otherwise medically underserved chronic disease populations.