The WrapApp

• Description:

  We are working with the Wraparound Project, a hospital-based violence intervention program (HVIP) that provides resources, mentorship, and case management to victims of violence. HVIPs are essential to reducing violent re-injury in the community through constant communication and follow-up between high-risk clients and culturally competent case managers. During activities in the Inspiration phase, we identified that this constant high-touch support and guidance required by dedicated case managers increased their risk of vicarious trauma and burnout. In the Ideation phase, we developed and tested "The WrapApp”, a mobile platform intended to enhance communication and planning between case managers and clients to prevent the likelihood of future violent injury. We plan to pilot this app with the Wraparound Project at San Francisco General Hospital in the summer of 2025.

• Research Publications:

  Abstracts Presented:
  
  Inspiration Phase - Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding Mechanism: CalVIP

• Project Lead: Marianna Salvatori

• Research and Community Partners: The Wraparound Project at ZSFGH, Code Tenderloin, Alternova

Wraparound Project + DCYF Youth Violence Prevention Bridge Program

• Description:

  Youth violence has been increasing in San Francisco. We are currently in the Inspiration phase of this project, researching how we might link the Wraparound Project with the Department of Children, Youth, and Their Families (DCYF) on the School Crisis Support Initiative (SCSI). SCSI aims to address and prevent violence involving students from the San Francisco Unified School District (SFUSD) through a comprehensive, collaborative, and community-centric approach. The initiative works to reduce the number of students involved in violent or serious conflicts both on and off campus, especially gun-related incidents, by coordinating rapid response de-escalation and violence prevention support for specific school sites designated by SFUSD. The goal of the Ideation and Implementation phase is to prototype and implement a solution that will provide transparency between violent injuries that matriculate to ZSFGH and the San Francisco school system to protect our city’s youth better.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase -forthcoming

  Implementation Phase -forthcoming

• Funding Mechanism: The Department of Children, Youth, and their Families (DCYF)

• Project Lead: Jennifer Reid, MD

• Research and Community Partners: The Wraparound Project at ZSFGH, DCYF

Data Management for Hospital-Based Violence Intervention Programs

• Description:

  In hospital-based violence intervention programs (HVIPs), there are wide variations in how data is collected and what is recorded. During the Inspiration phase of this project, we explored how to create a database that captures the complex stories of our patients who have experienced violence and supports efforts of fidelity in the field. In the Ideation phase, we designed and tested different solutions, ultimately deciding that integrating this database into the hospital's Electronic Health Record (EHR) would be the best approach. We are now in the Implementation phase, where we are piloting and refining this solution, which is currently being used by the Wraparound Project.

• Research Publications:

  Abstracts Presented: Hospital-Based Violence Intervention Program Database Design: Leveraging the Electronic Health Record, Academic Surgical Congress, Feb 2025, Las Vegas

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding Mechanism: CalVIP

• Project Lead: Caitlin Collins, MD MPH

• Research and Community Partners: The Wraparound Project at ZSFGH, The San Francisco Department of Public Health

Disparities in Well-being Outcomes Among Medical Students: The Impact of Disabilities

• Description: Medical students have diverse identities, some of which put them at higher risk for poor mental well-being and severe distress (i.e. disability). We used human-centered design (HCD) qualitative research methods in the Inspiration phase to better understand disability and its relation to medical students. In the Ideation phase, we are comparing well-being, protective and risk factors, and the interaction of modifiable variables between medical student cohorts with and without the identity of disability.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding Mechanism: Internal UCSF Funds

• Project Lead: Henry Seaborne

• Research and Community Partners: N/A

Mental Health Screening in Surgical After Care Clinic

• Description: Using HCD methodologies, we uncovered during the Inspiration and Ideation phases that there is a need to improve equitable access, efficiency, experience, and quality of care for trauma patients at the ZSFGH surgery clinic. During the Implementation phase, we collaborated with the Division of Trauma Recovery Services to screen all victims of violence for mental health disorders, such as PTSD and depression, with subsequent referrals and care coordination. This effort, along with other quality improvement projects by the Division of Surgery to address the unmet needs of surgical patients, will ultimately lead to improved patient outcomes and cost optimization.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase -forthcoming

• Funding: CPG SURF 5.0 Grant 

• Project Lead: Jennifer Reid, MD

• Research and Community Partners: UCSF Trauma Recovery Center

End of Life Care for Patients with Advanced Dementia

• Description:

  Providing end-of-life care for patients with advanced dementia can be complex, often leading to high-intensity and potentially unwanted treatments (i.e. mechanical ventilation, ICU admission, and resuscitation at the end of life). We applied a human-centered design lens through the Inspiration and Ideation phases to identify key insights from the clinician perspective, test hospital-based solutions, and redesign care delivery for patients with advanced dementia.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding Mechanism: California Healthcare Foundation

• Project Lead: Lara Chehab, MPH

• Research and Community Partners: Reset Health

Hand Infection Care at ZSFGH

• Description:

  If not cared for appropriately, hand infections can become infected and be a significant source of disability for patients. These infections are more common among vulnerable populations; however, no specific studies have assessed ways to improve care for this diagnosis in these groups. In the Inspiration phase, we identified key challenges providers and patients face in delivering proper care for hand infections. In the Ideation phase, we brainstormed and tested potential solutions with patients and providers. We co-designed and devised a discharge toolkit, and we plan to pilot it at ZSFGH with inpatients admitted for hand infections during the Implementation phase.

• Research Publications:

  Abstracts Presented -

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding Mechanism: Internal funding from the UCSF Division of Plastic & Reconstructive Surgery

• Project Lead: Alap U. Patel, MD

• Research and Community Partners: Mica Rosser, MD, Scott L. Hansen, MD

Developing Electronic Health Record-Enabled Interventions to Overcome Social Risk Limitations in the Emergency Department

• Description:

  Social determinants of health (SDOH) significantly impact patient outcomes, yet the unique demands of emergency departments (EDs) lack the time and resources to effectively screen, document, and address these risks. To bridge this gap, we are exploring how artificial intelligence (AI) and electronic health record (EHR) tools can improve social risk documentation and interventions without disrupting clinician workflows. In the Inspiration phase, we will study how ED clinicians currently document social risks in the EHR and identify challenges in the process. We will gather insights from ED clinicians on how social risks influence clinical decision-making and patient care, pinpointing pain points that could be addressed through EHR-based solutions. In the Ideation phase, we will apply human-centered design principles to develop and prototype an EHR-integrated tool that addresses key challenges. This tool will be tested in the ED setting to assess its feasibility in improving social risk documentation and patient care while minimizing the burden on clinicians. Through this project, we aim to enhance the role of EHR systems in mitigating health disparities and improving emergency care for vulnerable populations. In the Implementation phase, we will implement a refined version of the intervention in the ED.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding: Harold Amos Medical Faculty Development Program, Robert Wood Johnson Foundation

• Project Lead: Melanie Molina,MD, MAS, Julia Adler-Milstein, PhD, Laura Gottlieb, MD, MPH

• Research and Community Partners:

Using Clinical Decision Support to Provide Social Risk-Informed Care for Opioid Use Disorder in the Emergency Department

• Description:

  Emergency departments (EDs) play a critical role in initiating opioid use disorder (OUD) treatment, but social determinants of health (SDOH) often impact treatment adherence and follow-up. This study aims to enhance an existing electronic health record (EHR)-based clinical decision support (CDS) tool by integrating patient social risk data to improve social risk-informed OUD treatment in the ED. In theInspiration phase we aim to extract metadata from Epic’s reporting database to assess whether ED clinicians document and review discrete social risk data during OUD-related encounters. We will also conduct qualitative interviews and derive insights from ED staff and patient stakeholders. In the Ideation phase, our insights will inform prototypes for the integration of patient social risk data into the CDS tool. This will lead to the Implementation phase, where we will pilot a prototype that provides social care-enhanced OUD treatment recommendations. The feasibility and acceptability of this social care-enhanced CDS tool will be evaluated at the UCSF ED using a mixed-methods, before-after approach to measure its impact on treatment adherence and follow-up.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding: NIH, NIDA

• Project Lead: Melanie Molina,MD, MAS, Julia Adler-Milstein, PhD, Laura Gottlieb, MD, MPH

• Research and Community Partners:

GI Surgical Oncology Patient Navigation

• Description:

  Cancer patients, especially those needing treatment, surgery, and other tests, often struggle with navigating the complex scheduling and referrals across different departments involved in their care. To address this, we are collaborating with Dr. Ajay Maker and the UCSF Department of Surgical Oncology to uncover challenges in patient navigation specifically for GI cancer patients. In the Inspiration Phase, we are researching the experiences of both patients and providers in coordinating, delivering, and experiencing care. We are deriving insights and design opportunities in hopes to advance the patient navigation experience for complex cancer care.

• Research Publications:

  Inspiration Phase - forthcoming

• Funding: UCSF Department of Surgical Oncology

• Project Lead: Marianna Salvatori

• Research and Community Partners: Ajay Maker, MD, UCSF Department of Surgical Oncology

Injury Survivorship Clinic at ZSFGH

• Description:

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding:

• Project Lead: Marissa Boeck, MD MPH

• Research and Community Partners:

Project REACH

• Description:

  Project REACH, funded by the 2024 San Francisco General Hospital Foundation Equity & Innovation Grants, aims to reduce barriers to equitable surgical care for individuals experiencing homelessness. With over 8,000 people affected, traditional appointment-based systems often fail to meet their needs. By adopting a flexible "drop-in" clinic model for surgeries, Project REACH provides a more accessible and responsive approach to care.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Project Lead: Marissa Boeck, MD MPH, Hannah Decker, MD, Joanna Eveland, MD

• Research and Community Partners: SFGH Foundation Equity & Innovation Grants

American College of Surgeons Trauma-Informed Care Curriculum

• Description:

  Trauma-informed care (TIC) focuses on training healthcare staff to better support patients with complex needs by understanding and responding to the impact of trauma. In 2021, the American College of Surgeons developed a 4-hour TIC training program, which was piloted in 21 trauma centers across the U.S., including Zuckerberg San Francisco General Hospital. After the 2023 pilot, The Better Lab used human-centered design to assess how the curriculum was implemented and its effectiveness (Inspiration phase). We then completed the Ideation phase, creating new curriculum content and recommendations. We are now in the Implementation phase, piloting curriculum enhancements for local and national rollout.

• Research Publications:

  Abstracts Presented - The Implementation and Evaluation of a National Trauma Informed Care Curriculum Pilot: A Single-Center Experience, UCSF Department of Surgery Research Symposium, May 2024, UCSF

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding: UCAAN

• Project Lead: Adrienne Greer, MPH

• Research and Community Partners: Triads, Trauma Transformed

Trauma-Informed Perioperative Care

• Description:

  Trauma-informed care (TIC) is crucial for helping physicians support patients with emotional and physical trauma, empowering them to take control of their care. However, adapting TIC in fast-paced acute care settings, like emergency and surgical environments, is not well understood. Using human-centered design, we conducted interviews with surgical providers at ZSFGH during the Inspiration phase to better understand the acute care environment and how care is adapted for trauma-affected patients.

• Research Publications:

  Abstracts Presented - Exploring Gaps in Trauma-Informed Care in the Perioperative Setting: A Qualitative Study at a Federally Qualified Health Center, United California Community Health Conference (UCCHC), April 2024, UC Davis School of Medicine

  Using Human Centered Design to Overcome Barriers for Trauma-Informed Care (TIC) in a Perioperative Setting, December 2023, UCSF Summer Explore Poster Session

  Inspiration Phase - forthcoming

• Funding: Internal UCSF Funding

• Project Lead: Angelica McDaniel

• Research and Community Partners: Faithful Fools

Temple University Trauma-Informed Care

• Description:

  Clinicians, staff, and leadership at Temple University Trauma Center have partnered with our team in hopes of delivering revolutionized Trauma-informed care to their patients. Using HCD, we held focus groups during the Inspiration Phase and analyzed the data to design a workshop that catapulted brainstorming solutions for the Ideation Phase. We are working towards the Implementation Phase, which will pilot and evaluate the selected solution.

• Research Publications:

  Abstracts Presented - Using Human-Centered Design to Support Trauma-Informed Care for Firearm-Injured People, 2024 National Research Conference for the Prevention of Firearm-Related Harms, Dec 2024, Seattle

  Inspiration Phase & Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding: Temple University

• Project Lead: Adrienne Greer, MPH

• Research and Community Partners: Temple University

Tanzanian Tumor Board

• Description:

  In collaboration with Dr. Mary Xu of UCSF and the Muhimbili Ocean Road Cancer Institute (ORCI), this human-centered design (HCD) research project aims to improve cancer care delivery in Tanzania by redesigning tumor boards. The initiative focuses on enhancing internal case-based discussions, transforming tumor boards into effective clinical platforms, and strengthening multidisciplinary collaboration in oncology care. The project seeks to expand disease-specific tumor boards to support education, registry data collection, and quality improvement while gathering insights from patients and providers to optimize the timing and coordination of care. It also addresses key challenges such as provider availability, virtual and hybrid formats, and the need for improved communication and documentation. This research is part of a broader effort to enhance the efficiency, effectiveness, and patient-centered nature of oncology care in Tanzania.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding:

• Project Lead: Marianna Salvatori

• Research and Community Partners: Mary Xu, MD

Medical Student Wellbeing

• Description:

  Medical student wellbeing is a critically important but understudied topic. We recently completed the largest survey of medical student wellbeing ever conducted. In addition to the survey, we conducted more than 20 in-depth interviews with medical students. Analysis of this data revealed that more than 50% of medical students met the criteria for severe distress, and 20% of all students surveyed had taken or considered taking a leave of absence for personal wellbeing. We also found that distress among medical students was exacerbated by multiple factors, including gender identity and debt burden. We continued to examine these associations to further understand the landscape of medical wellbeing. Through this work, we aimed to identify coping mechanisms, habits, and characteristics of medical students that promoted resilience and reduced distress. Our goal was to use this data to develop interventions that fostered medical student wellbeing and reduced burnout.

• Research Publications:

  Medical students in distress: The impact of gender, race, debt, and disability

  Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources

  Disparities in well-being outcomes among medical students: a comparative study between medical students with and without disability

• Funding:

• Project Lead: Nikhil Rajapuram, MD

• Community and Research Partners: Megan Marshall

Virtual Reality Training Program to Improve Trauma Care

• Description:

  Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there was a shift to practicing skills through simulations with mannequins or patient actors. Virtual Reality (VR), and in particular, the use of 360-degree video and audio (cineVR), became the next-generation advance in medical simulation with novel applications to augment clinical skill practice, empathy-building, and team training. For this project, we focused on high-level trauma care at ZSFG, where out of approximately 255 trauma cases admitted each month, 90 were high-level “900 activations” requiring speed and intense coordination across multiple departments. We developed a training experience using cineVR and eye-tracking technology to help trainees in surgery, anesthesia, and emergency medicine experience real and simulated 900 trauma activations from different perspectives, such as the charting nurse, the attending, and their fellow providers.

• Research Publications:

  Technical Methods Paper: Developing Virtual Reality Trauma Training Experiences Using 360-Degree Video: Tutorial

  Book Chapter: The Power of Virtual Reality Cinema for Healthcare Training: A Collaborative Guide for Medical Experts and Media Professionals

• Funding: SF General Hospital Foundation

• Project Lead: Devika Patel, MS, Amanda Sammann, Lara Chehab, Benjamin Alpers, Sophia Pink, Jerome Wang, Jonathan Freise

• Research and Community Partners: Ohio University GRID Lab; Patrick Martin-Tuite, Joshua Feler, Amy Tan, Phillip Koim, Christopher Peabody, John Bowditch, Eric R Williams

Trauma Rounding

• Description: Daily patient rounds are essential for care delivery because they allow for providers to collaboratively develop a care plan while providing the patient and their family the opportunity to communicate with their care team. The trauma service at ZSFG has the highest number and complexity of patients of any other service. Whereas other services completed their rounds in an average of two hours, the trauma team could take up to five hours each morning visiting their patients. In addition to the high patient census and complexity, a variety of non-clinical factors contributed to the efficiency and experience of the rounding process. This project aimed to uncover those factors and collaborate with users to simultaneously improve the efficiency of the rounding process for the trauma team and enhance the experience of rounds for all users—providers, staff, medical students, interns, patients, and their families.

• Research Publications:

  Inspiration Phase - Using a human-centered, mixed methods approach to understand the patient waiting experience and its impact on medically underserved Populations

  Ideation Phase - Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital

  Implementation Phase - forthcoming

• Funding:

• Project Lead: Lara Chehab, MPH

• Research and Community Partners: ZSFG Trauma Surgery Service

PPE Redesign

• Description: Personal protective equipment (PPE) compliance amongst healthcare workers is low nationally. Trauma care providers are at significant risk of body fluid exposure. We identified poor PPE compliance rates of 29% among trauma care providers at our institution. Through HCD research with trauma care providers and staff, we identified two design opportunities to improve PPE compliance: enhancing the donning process and improving convenient access to PPE storage. Brainstorming yielded 216 ideas, which were organized into 12 discrete categories. The three ideas selected for further development included:

  1. PPE Fanny Pack – PPE stored in a fanny pack or backpack that each provider wore.

  2. Role-Specific PPE Packs – PPE packaged and placed in relevant locations in the trauma bay, containing role-appropriate PPE.

  3. All-In-One PPE Kit – A gown with gloves, mask, and hair cover attached to the gown.

  User feedback indicated that the All-In-One PPE Kit was the most desirable. This idea was refined into a PPE Bundle: a gown with necessary PPE components adhered to it at ergonomic positions. A rack with a quick-release mechanism was developed to hang the PPE bundle from existing PPE storage systems. Next steps included refining the physical design of the prototype and conducting user testing in clinical settings to assess compliance, effectiveness, and acceptability.

• Research Publications:

  AAST 2020 conference abstract: From Opportunities to Prototypes: Redesigning Personal Protective Equipment in Trauma Care

• Funding: Patient Care funds at UCSF/ZSFG

• Project Lead: Patrick Martin-Tuite, MD, MS, Devika Patel, MS

• Research and Community Partners: ZSFG Emergency Department

Improving Access, Efficiency, and Experience at ZSFGH Surgical Clinic

• Description:

  This project aimed to improve access, efficiency, and experience for patients, providers, and staff at a general surgery outpatient clinic at ZSFG.

  Access: In our pre-COVID research, we used HCD interviews and predictive analytics to develop insights and opportunities for understanding the 30% no-show rate in the clinic and prototyped various transportation-related solutions to help patients overcome barriers to attendance. We later identified insights and opportunities for designing a system of remote surgical care that could improve both access and efficiency of clinic visits without compromising outcomes.

  Efficiency: In our pre-COVID research, we found that patients often spent over two hours in the clinic for a short outpatient visit. Using a combination of HCD and time-tracking observations, we identified bottlenecks and pain points.

  Experience: In our pre-COVID research, we used HCD interviews and architectural mapping techniques to develop insights and opportunities for understanding the patient experience in the waiting room.

• Research Publications:

  Inspiration Phase - Using a human-centered, mixed methods approach to understand the patient waiting experience and its impact on medically underserved populations

  Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital

  Ideation Phase -

  Implementation Phase -

• Funding:

• Project Lead: Devika Patel, Amanda Sammann, Lara Chehab, Elizabeth Liao, Jennifer Liao, Michelle Ossmann, Benjamin Alpers, Kathryn Neville

• Research and Community Partners: Department of Surgery, ZSFG Surgical Clinic

Covid-19 Experiences

• Description:

  At the time of writing, over 78 million cases of COVID-19 had been documented worldwide. Of those, approximately 76 million people had recovered from the disease. In North America, nearly 19 million people had tested positive for the virus, with 18.5 million of those having recovered or actively recovering. This project was a multi-centered design study aimed at understanding the recovery experience of people diagnosed with COVID-19 in North America. The goal of the study was to compare the recovery experiences of hospitalized and non-hospitalized patients across San Francisco, Los Angeles, Michigan, Chicago, and Toronto to inform recovery programs that could provide necessary and continued support to people during their recovery.

• Research Publications:

  Inspiration Phase - Scale, Scope, Speed: Reflections on a Multi-site Covid-19 Study

  Ideation Phase -

  Implementation Phase -

• Funding:

• Project Lead: Lara Chehab, MPH

• Community and Research Partners: Emergency Design Collective; Kim Erwin, Santosh Basapur, Aalap Doshi, Linde Huang, Serena Liang Jing, Christopher Rice, Xinrui Xu, Sean Molloy​

Improving Perinatal Healthcare Delivery

• Description:

  Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. We used human-centered design to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. We engaged a total of 171 stakeholders across the Inspiration and Ideation phases of the HCD methodology.

• Research Publications:

  Inspiration & Ideation Phase - Using human centered design to identify opportunities for reducing inequities in perinatal care

  Implementation Phase - Project Concluded

• Funding: SF Respect Initiative

• Project Lead: Devika Patel

• Research and Community Partners: Dr Malini Nijagal and Schyneida Williams, Homeless Prenatal Program, Team Lilly

Solid Start

• Description: This project was inspired by the Solid Start Initiative’s interest in better understanding transitions within the perinatal system of care at ZSFG to improve care coordination and overall experience. The Inspiration phase revealed that patient information was often lost across transitions of care and that providers relied on patients to report valuable and sensitive information. While this information was essential for providers and community organizations to deliver appropriate services, the process inappropriately placed this responsibility on the patient. The Ideation phase identified four main work streams to address the themes, insights, and design opportunities revealed in the Inspiration phase: Honor the Patient Story, Build a Robust Relationship, Interpersonal Violence Education and Support, and The Transition from Labor and Delivery. Solution ideas for each workstream were generated with stakeholders through a series of brainstorming sessions, resulting in 12 prototype concepts. The Implementation phase iteratively tested and refined five prototype concepts with patients and providers over a series of 23 in-person, in-context testing sessions. Due to project timeline constraints, only three prototypes were implemented in patient care environments, including the 5M and 6M clinics and the Homeless Prenatal Program.

• Research Publications:

  Facilitating Integrated Perinatal Care for Families Affected by Substance Use

• Funding: Solid Start

• Project Lead: Benjamin Alpers, MS, Devika Patel, MS

• Research and Community Partners: Solid Start, Homeless Prenatal Program, Team Lilly, OB Psychiatry Clinic, Plan of Safe Care Collaborative Perinatal Health

Trauma-Informed Care for Spanish-Speaking Patients

• Description:

  Trauma-informed care (TIC) was a framework for improving care for patients who had experienced trauma. However, its implementation for patients with limited English proficiency, particularly in trauma and acute care surgery, was not well understood.

  Using a human-centered design approach in the Inspiration phase, we identified key insights from both clinicians and patients. We then entered the Ideation phase, aiming to redesign how TIC was delivered to Spanish-speaking patients in acute care surgery.

• Research Publications:

  Abstracts Presented - Using Human-Centered Design to Improve Trauma-Informed Care for Spanish-Speaking Patients Receiving Acute Care Surgery, UCSF Department of Surgery Resident Research Symposium, May 2024, UCSF

• Funding: UCSF School of Medicine Inquiry Funding

• Project Lead: Manami Diaz Tsuzuki

• Research and Community Partners: The Wraparound Project

99DOTS Digital Adherence Technology in Uganda

• Description: Tuberculosis (TB) is the leading cause of infectious disease death worldwide. However, globally, treatment adherence is much lower than the WHO-recommended level of 90%. In Uganda, treatment adherence ranges from 60-75%. We utilized human-centered design to redesign a current digital adherence technology called 99DOTS to better suit the needs and priorities of Ugandan TB patients.

• Research Publications:

  Inspiration Phase - Opportunities to improve digital adherence technologies and TB using human-centered design

  Ideation Phase -Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods

  Implementation Phase - Digital adherence technology for tuberculosis treatment supervision: A stepped-wedge cluster randomized trial in Uganda

• Funding: STOP TB

• Project Lead: Devika Patel, MS

• Research and Community Partners: Dr. Adithya Cattamanchi, Dr. Christopher Berger, Uganda Tuberculosis Implementation

3HP: Tuberculosis Preventative Treatment Adherence in Uganda

• Description: Recently, the World Health Organization recommended a 3-month (12-dose) regimen of weekly isoniazid and rifapentine (3HP) for the prevention of tuberculosis (TB) among people living with HIV (PLHIV) on common antiretroviral therapy regimens. However, the optimal method for delivering 3HP to PLHIV remains uncertain. To address this, a 3-armed randomized trial was conducted, where participants were assigned to either the Directly Observed Therapy (DOT) arm, the Self-Administered Therapy (SAT) arm, or a choice arm, allowing patients to select DOT or SAT using a shared decision-making tool. DOT involves a weekly visit to a healthcare provider for dosing and monitoring of side effects, while SAT requires a weekly phone call to confirm adherence, with in-person visits only for refills. We collaborated with Dr. Adithya Cattamanchi's team to develop a shared decision-making aid to help patients choose their preferred treatment delivery method: DOT or SAT. Additionally, we designed the experience for patients assigned or opting for SAT by creating a carrying case for their medication and planning the call-in process. Tuberculosis (TB) remains the leading cause of infectious disease death globally, but adherence to treatment is often below the WHO's recommended level of 90%, with Uganda's adherence rates ranging from 60-75%. There is an urgent need for improved ways to track adherence and provide effective care. Digital adherence technologies, which help monitor patient compliance, are one potential solution. We are partnering with Global Health Labs to design, prototype, and test an innovative TB medication adherence technology to assist patients and providers in monitoring adherence. Drawing from prior research phases, including the redesign of 99DOTS and work on TB preventive treatment for PLHIV, our efforts have already led to a 10% increase in TB medication adherence in Uganda.

• Research Publications:

  Inspiration Phase - Opportunities to improve digital adherence technologies and TB care using human-centered design

  Ideation Phase - forthcoming

  Implementation Phase - Comparison of 3 optimized delivery strategies for completion of isoniazid-rifapentine (3HP) for tuberculosis prevention among people living with HIV in Uganda: A single-center randomized trial

• Funding: NIH RO1

• Project Lead: Devika Patel, MS, Amanda Sammann, MD, MPH, Lara Chehab, MPH, Christopher Berger, Kathryn Neville

• Research and Community Partners: Global Health Labs, A Kityamuwesi, J Ggita, L.K. Tinka, P. Turimumahoro, A.Z. Chen, N. Gupta, S. Turyahabwe, A. Katamb, A. Cattamanchi ​

Developing Novel Digital Adherence Technologies to Improve Tuberculosis Medication Adherence in Uganda

• Description: Tuberculosis (TB) remains the leading cause of death from infectious diseases worldwide, yet treatment adherence globally falls short of the WHO's recommended 90%, with rates in Uganda ranging from 60-75%. This highlights the urgent need for improved methods to track patient adherence and provide enhanced care. Digital adherence technologies, which utilize technological tools to monitor patient adherence, offer a promising solution. Our collaboration with Global Health Labs focuses on designing, prototyping, and testing an innovative TB medication adherence technology to support patients and providers in monitoring treatment adherence. We build on insights gained from previous research phases, including the redesign of 99DOTS and work on TB preventive treatment for people living with HIV. Our efforts have already led to a 10% increase in TB medication adherence in Uganda.

• Research Publications:

  Inspiration Phase - forthcoming

  Ideation Phase - forthcoming

  Implementation Phase - forthcoming

• Funding: Global Health Labs

• Project Lead: Devika Patel, MS

• Research and Community Partners: Dr. Adithya Cattamanchi, Dr. Christopher Berger, Uganda Tuberculosis Implementation