May 21, 2014
Gamification Concept Used To Quickly Improve Patients’ Blood Pressure
April Flowers for redOrbit.com - Your Universe Online
This week, Merriam-Webster released a list of new words being added to the dictionary, including gamification: the use of game thinking and game mechanics in a non-game context to engage users. What could gamification have to do with medical education, though?
A new study from Brigham and Women's Hospital (BWH) and the Veterans Affairs Boston Healthcare System has employed the concept of gamification in the education of clinicians treating hypertension, with positive results.
The blood pressure control of patients seeing doctors and nurses participating in an online, competitive game to solve hypertension cases improved in a shorter amount of time than patients of non-gaming care providers. The study findings were published in Circulation: Cardiovascular Quality and Outcomes.
"This study is the first to show that an online educational game among medical professionals can improve the health measures of their patients," said Alexander Turchin, MD, MS, director of Informatics Research, BWH Division of Endocrinology.
The game used spaced education, a technique in which students are shown to significantly increase knowledge retention when the information is presented and reinforced over spaced intervals of time.
The online spaced-education game was developed by B. Price Kerfoot, MD, EdM, staff surgeon, Veterans Affairs Boston Healthcare System. Kerfoot also invented the technique of spaced education, which Harvard is seeking to patent.
Primary care clinicians who participated in the game were found to have improved their knowledge of high blood pressure management, which in turn generated a modest, but significant, decrease in the time it took their patients to reach blood pressure targets.
“Clinicians may be familiar with the guidelines, but often that knowledge isn’t translated effectively into practice,” Kerfoot said. “Spaced education appears to engage learners in such a way that translates evidence-based guidelines into clinician practice patterns. Testing can help with retention.”
The study, which took a little over a year, was a two-arm, randomized trial. Clinicians at eight Veterans Affairs hospitals in the northeast US participated. The 111 participants were randomly assigned to one of two groups: the first received educational content about lowering blood pressure in the form of an online game, the second received the identical content through a static online posting. Of the original cohort, 48 completed the game and 47 completed reading the online posting.
The educational content for both groups consisted of 32 validated case studies followed by multiple-choice questions with explanations on hypertension management. Gaming clinicians were emailed one question every three days. If answered incorrectly, the question was resent in 12 days, compared to 24 days if answered correctly. Once a question was answered correctly twice in a row, it was retired. To foster competition and a greater desire to "win" the game, clinician's scores were publicly posted.
“The competition proved to be a powerful incentive,” said Kerfoot.
The researchers measured the time it took for 14,336 patients to reach their target blood pressure (140/90 mm Hg) over 17,866 hypertensive periods. What they found is that patients of the clinicians involved in the game reached their goals in 142 days, versus the 148 days required for patients whose clinicians were not involved in the game. The research team says that the difference is modest, but significant.
Kerfoot said that for every one doctor who participated in the game, 2.3 additional patients reached normal blood pressure during the study period.
“If you train one clinician you can impact many patients. There is a strong amplification effect,” he added.
“The study shows that an easy-to-use, low-cost tool can influence doctors and benefit patients,” said Turchin. “Once you’ve designed the emails, you can send it to 10 people or to every single doctor in the United States without increasing your costs.”
"Based on our findings, educational games may be effective tools to engage health professionals, boost learning, optimize practice patterns, and improve patient outcomes," said Turchin. "We hope that future studies continue to focus on figuring out how to most effectively integrate games into the education of health professionals for the benefit of their patients."
Harvard has launched a company called Qstream to develop and disseminate the spaced education methodology outside of its firewalls. Any clinician is invited to join the game on Qstream's website.
Funding for the study was obtained from the Research Career Development Award Program and research grant from the Veterans Affairs Health Services Research and Development Service, the American Urologic Association Foundation, Astellas Pharma US Inc., Wyeth Inc., and the National Institutes of Health.