Richard J Holden

• Vanderbilt University

Background The 5-Cog paradigm is a 5-minute brief cognitive assessment coupled with a clinical decision support tool designed to improve clinicians’ early detection of cognitive impairment, including dementia, in their diverse older primary care patients. The 5-Cog battery uses picture- and symbol-based assessments and a questionnaire. It is low co...

Background Participant recruitment and retention are critical to the success of clinical trials, yet challenges such as low enrollment rates and high attrition remain ongoing obstacles. RecruitGPS is a scalable dashboard with integrated control charts to address these issues by providing real-time data monitoring and analysis, enabling researchers...

Introduction Individuals with food insecurity are disproportionately burdened by hypertension (HTN) and type 2 diabetes and face greater barriers to self-managing these conditions. Methods Food Resources and Kitchen Skills (FoRKS) is an ongoing 2-arm parallel randomized controlled trial (RCT) that will enroll 200 adults (35–75 y) with food insecur...

[This corrects the article DOI: 10.2196/60353.].

For unpaid care partners of community-dwelling people living with Alzheimer’s disease and related dementias (ADRD), medication management is effortful and time-consuming work that often continues over several years. Although this work may be eased by mobile application software (apps), current consumer apps underserve care partners’ needs. Through...

UNSTRUCTURED Digital health interventions are a promising method for delivering timely support to underresourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in participatory design (PD). In recent years, there has been a shift toward conducting PD remotely, which may enable p...

Background Clinical trial success hinges on efficient participant recruitment and retention. However, slow accrual and attrition frequently hinder progress. To address these challenges, a novel dashboard tool with control charts has been developed to provide investigators on the multi-site study of Delirium and Neuropsychological Recovery among Eme...

Background Older adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions and have been repeatedly associated with poor cognitive out...

Objectives Older adults’ (ages ≥65) inappropriate over-the-counter medications (OTC) use is prevalent, comprising Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Given that pharmacies sell many OTCs, structurally redesigning pharmacy aisles for improving patient safety (Senior Safe) was conceived to mitigate older adult OTC misuse, using S...

BACKGROUND Clinical trial success depends on efficient participant recruitment and retention, yet low enrollment and high attrition remain persistent challenges. To address these issues, we developed RecruitGPS, a scalable dashboard that provides investigators with timely data to improve subject participation and recruitment outcomes. OBJECTIVE Th...

BACKGROUND Caregiver-assisted medication management plays a critical role in promoting medication adherence and quality of life for people living with Alzheimer’s disease or related dementias (ADRD). Caregivers of people living with ADRD can benefit from interventions tailored to their medication management needs; however, the needs of caregivers r...

Background: Older adults commonly experience chronic medical conditions and are at risk of cognitive impairment as a result of age, chronic comorbidity, and medications prescribed to manage multiple chronic conditions. Anticholinergic medications are common treatments for chronic conditions, and have been repeatedly associated with poor cognitive o...

BACKGROUND The 5-Cog paradigm is a 5-minute brief cognitive assessment coupled with a clinical decision support tool designed to improve clinicians’ early detection of cognitive impairment, including dementia, in their diverse older primary care patients. The 5-Cog battery uses picture- and symbol-based assessments and a questionnaire. It is low co...

BACKGROUND Digital health interventions are a promising method for delivering timely support to under-resourced family caregivers. The uptake of digital health interventions among caregivers may be improved by engaging caregivers in their design through Participatory design (PD). Recent years have seen a shift towards conducting PD remotely, which...

Purpose of Review The purpose of this study was to conduct a scoping review to map intervention, sample, and physiologic measurement characteristics of lifestyle interventions for gestational diabetes mellitus (GDM) prevention. Recent Findings A total of 19 studies met selection criteria from 405 articles screened (PubMed, Web of Science). No stud...

BACKGROUND In today’s digital age, web-based applications have become integral to daily life, driving transformative shifts in human behavior. "AgileNudge+” is a web-based solution to catalyze positive behavior change. By leveraging knowledge in behavioral economics, design, and technology, AgileNudge+ utilizes nudging interventions to facilitate l...

Background In today’s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. “AgileNudge+” (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating...

Over-the-counter (OTC) medications with anticholinergic effects (e.g. doxylamine, diphenhydramine) are widely used by older adults, despite their association with an increased risk of Alzheimer’s disease and related dementias (ADRD). Authoritative bodies, such as the American Geriatrics Society and National Academy of Medicine, recommend discouragi...

As industry consolidation leads to a growing number of large new healthcare delivery networks, patients and their clinicians are losing the important human-centric and relationship-based nature of medical care. The leadership of Hackensack Meridian Health (HMH), a New Jersey-based network of hospitals, research center, and medical school, made an o...

Introduction: The Agile Nudge University is a National Institute on Aging-funded initiative to engineer a diverse, interdisciplinary network of scientists trained in Agile processes. Methods: Members of the network are trained and mentored in rapid, iterative, and adaptive problem-solving techniques to develop, implement, and disseminate evidenc...

In this correspondence, we explain the reasoning for invalidity of the analysis choices by Kolberg et al., and provide the results produced using correct statistical procedures for their study design. Reassuringly, we could verify the original conclusions. That is, results of the corrected statistical models are similar to the results of the origin...

Background The primary aim of the current pilot study was to examine enrollment rate, data completion, usability, acceptance and use of a mobile telehealth application, Brain CareNotes. A secondary aim was to estimate the application's effect in reducing caregiver burden and behavioral and psychological symptoms related to dementia (BPSD). Methods...

BACKGROUND Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. OBJECTI...

Background Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for ur...

Background Industrywide, primary care nurses’ work is increasing in complexity and team orientation. Mobile health information technologies (HITs) designed to aid nurses with indirect care tasks, including charting, have had mixed success. Failed introductions of HIT may be explained by insufficient integration into nurses’ work processes, owing to...

Food insecurity affects nearly 50 million Americans and is linked to cardiovascular disease risk factors and health disparities. The purpose of this single-arm pilot study was to determine the feasibility of a 16-week dietitian-led lifestyle intervention to concurrently address food access, nutrition literacy, cooking skills, and hypertension among...

Background and objectives: Informal (or family) caregivers to older adults with Alzheimer's disease or other related dementias (ADRD) could greatly benefit from innovative telecaregiving systems that support caregiving from a distance. The objective of this review is to better understand: 1) who is involved in telecaregiving and their experiences;...

Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medication...

Mobile health (mHealth) technologies can offer a low-cost, easy-access approach to support health and healthcare. However, their design and implementation do not always fit end-users and care practices, presenting a significant barrier to success. This chapter specifies that applying human factors engineering and user-centered design is critical fo...

Precipitated by the COVID-19 pandemic, many work systems—including those focused on research activities—have transitioned to remote operations and many may remain remote even after in-person operations no longer present a public health risk. The ability to conduct human subjects research remotely presents many benefits but also numerous challenges....

This panel session is for anyone in human factors and ergonomics (HFE) or related disciplines interested in recruiting, hiring, admitting, retaining, and promoting people within organizations from the perspective of pursuing authentic diversity. Applicants and hiring managers may also gain insight on what makes a meaningful diversity statement, a t...

Society relies upon informal (family, friend) caregivers to provide much of the care to the estimated 43.8 million individuals living with Alzheimer's disease and related dementias globally. Caregivers rarely receive sufficient training, resources, or support to meet the demands associated with dementia care, which is often associated with increase...

Background The number of oral anticancer medications has increased over the past few decades, opening new possibilities in cancer care and improving convenience for patients and caregivers. However, adherence levels continue to be suboptimal, potentially jeopardizing therapeutic benefits. Poor adherence levels may indicate gaps in current strategie...

At present, many clinicians are frustrated with the electronic health record (EHR) systems implemented in their hospital or clinic. This is leading to record numbers of clinicians claiming to be burned out due to the EHR. Although there are multiple factors involved, a principal reason for clinicians’ frustration is poor support by the EHR for end-...

Background and objective Systematically supporting caregiver-assisted medication management through IT interventions is a critical area of need toward improving outcomes for people living with ADRD and their caregivers, but a significant gap exists in the evidence base from which IT interventions to support caregivers' medication tasks can be built...

OBJECTIVES/GOALS: Children with medical complexity (CMC) experience frequent transitions of care (e.g., hospital to home) and are at increased risk for medication-related harm. This study aimed to identify transition-related medication safety barriers experienced by family caregivers, as they shoulder most of the caregiving responsibility following...

Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human work performance and wellbeing in sociotechnical systems. HFE in pharmacy involves the human-centered design of systems to support individuals and teams who perform medication-related work. We define the scope of HFE methods in...

Background Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-i...

BACKGROUND The over 11 million care partners in the US who provide care to people living with Alzheimer’s disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to all aspects of their caregiving role. The proliferation of mobile applications (apps) for care partners has potential to meet the care partners’ needs, bu...

Background: Over 11 million care partners in the United States who provide care to people living with Alzheimer disease and related dementias (ADRD) cite persistent and pervasive unmet needs related to their caregiving role. The proliferation of mobile apps for care partners has the potential to meet care partners' needs, but the quality of apps i...

Food and nutrition are important to ensuring health, and practices related to food (including obtaining, preparing, consuming, sharing and cleaning up food) involve effortful activity - work. Human Factors and Ergonomics (HF/E) efforts that leverage expertise in across HF/E domains (i.e., physical, cognitive and organizational ergonomics) can provi...

Deprescribing is the process of withdrawing or replacing medications to improve outcomes and reduce medication-associated risks. Deprescribing, though traditionally the domain of healthcare professionals, is now receiving attention from human factors experts. In turn, the deprescribing community is gaining an appreciation for human-centered design...

Human Factors/Ergonomics (HF/E) is a systems discipline focused on jointly optimizing human well-being and overall system performance. Societal problems, including but not limited to health inequity, racism, poverty, and (lack of) sustainability, are inherently systems problems that involve humans, and so recent work has argued that HF IE can and s...

Telemedicine implementation in ambulances can reduce time to treatment for stroke patients, which is important as “time is brain” for these patients. Limited research has explored the demands placed on acute stroke caregivers in a telemedicine-integrated ambulance system. This study investigates the impact of telemedicine on workload, teamwork, wor...

Current models of the deprescribing process are largely clinician driven and limited to a single point in time. Our objective with this work was to investigate the effects of these existing models on interventions targeting older adults. Studies identified in an existing systematic literature review were examined and classified in terms of who with...

In the 4th panel on the topic of The Patient in Patient Safety, we highlighted topics of current relevance and facilitated a reflection session. The objective was to highlight the ways in which the COVID-19 pandemic has impacted patient ergonomics research and work, with particular focus on safety. After a topic overview, panelists presented their...

Patient ergonomics is, simply put, the science (and design) of patient work. Patient work is the effortful, goal-driven, and consequential health-related activity performed by patients, families, and others independently or in concert with healthcare professionals. Patient work is hard work, occurs in context, unfolds as a journey, is a team effort...

Background Human factors and ergonomics (HFE) is a scientific and practical human-centered discipline that studies and improves human performance in sociotechnical systems. HFE in pharmacy promotes the human-centered design of systems to support individuals and teams performing medication-related work. Objective To review select HFE methods well s...

Dr. Ben-Tzion (Bentzi) Karsh was a mentor, collaborator, colleague, and friend who profoundly impacted the fields of human factors and ergonomics (HFE), medical informatics, patient safety, and primary care, among others. In this paper we honor his contributions by reflecting on his scholarship, impact, and legacy in three ways: first, through an u...

IMPACT: This study will generate preliminary data to address a critical, care transition-related patient safety gap involving medication use among children with medical complexity. OBJECTIVES/GOALS: The objectives of this study are: (1) to understand care transition-related medication safety risks for children with medical complexity (CMC), and (2)...

Objective: To test the impact of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults. Design: Cluster-randomized controlled trial. Setting and participants: Ten primary care clinics within Eskenazi Health in Indianapolis. Intervention: The multicomponent interventio...

Innovation is essential to transform healthcare delivery systems, but in complex adaptive systems innovation is more than ‘light bulb events’ of inspired creativity. To achieve true innovation, organisations must adopt a disciplined, customer-centred process. We developed the process of Agile Innovation as an approach any complex adaptive organisat...

Background Informal caregivers of patients with Alzheimer’s disease and related dementias (ADRD) manage a complex spectrum of patient behavioral and psychological symptoms of dementia (BPSD). Mobile health information technologies have quickly become sources for modern social support and chronic disease management. These technologies can improve ou...

We present a novel view of transitions from the lens of patient ergonomics (the “science of patient work”), which posits that patients and other non-professionals perform effortful work towards health-related goals. In patient work transitions, patients experience changes in, for example, health, task demands, work capacity, roles and responsibilit...

Background: Every day, older adults living with heart failure make decisions regarding their health that may ultimately affect their disease trajectory. Experts describe these decisions as instances of naturalistic decision making influenced by the surrounding social and physical environment and involving shifting goals, high stakes, and the invol...

Background: The COVID-19 pandemic necessitated "going remote" with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populatio...

BACKGROUND The COVID-19 pandemic necessitated “going remote” with the delivery, support, and assessment of a study intervention targeting older adults enrolled in a clinical trial. While remotely delivering and assessing technology is not new, there are few methods available in the literature that are proven to be effective with diverse populations...

In health and healthcare, patients, families, and other stakeholders increasingly participate in designing, executing, and evaluating initiatives likely to affect them. Stakeholder participant roles include: (1) Advisors, as in patient/family advisory councils; (2) Co-Designers, as in participatory design team members; (3) Citizen Scientists, as in...

Over the last several years, a number of human factors researchers have been integral to the advent and success of AHRQ’s Patient Safety Learning Laboratories (PSLLs). This panel is made up of researchers involved in this program of research and co-chaired by two different project PIs. The goal of this panel is to share what panelists have learned...

BACKGROUND Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-i...

Introduction A growing body of scientific evidence points to the potentially harmful cognitive effects of anticholinergic medications among older adults. Most interventions designed to promote deprescribing of anticholinergics have directly targeted healthcare professionals and have had mixed results. Consumer-facing technologies may provide a uniq...

Personas can be used to understand patterns of variation in patients’ performance of cognitive work, particularly self-care decision making. In this study, we used a patient-centered cognitive task analysis (P-CTA) to develop self-care decision-making personas. We collected data from 24 older adults with chronic heart failure and 14 support persons...

In a panel format, four systems researchers who are also patients described their experiences navigating their care continuum in relation to human factors topics. Getting inside the heads of researcher-patients is an opportunity to elicit unique perspectives on healthcare, which may not be captured through research alone. Researcher-patients may na...

Background Heart failure (HF) is a growing public health problem in the United States. Implantable cardiac resynchronization therapy (CRT) devices reduce mortality and morbidity, and remote monitoring (RM) of these devices improves outcomes. However, patient RM adherence is low, due in part to lack of access to their RM data. Providing these data t...

Background User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective This study aims to characterize the practical challenges encountered and pr...

Primary health care is a complex, highly personal, and non-linear process. Care is often sub-optimal and professional burnout is high. Interventions intended to improve the situation have largely failed. This is due to a lack of a deep understanding of primary health care. Human Factors approaches and methods will aid in understanding the cognitive...

Introduction: Primary care is complex due to multiple health problems being addressed in each patient visit. Little is known about the effect of the number of problems per encounter (NPPE) on the resulting clinician workload (CWL), as measured using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Methods: We evaluat...

BACKGROUND User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. OBJECTIVE This study aims to characterize the practical challenges encountered and pr...

Self-care is a process with which all people will engage at some point in their lives, whether healthy, healing from an acute health situation, or living with chronic illness. As such, there are different types of self-care with unique components and challenges. Each challenge presents an opportunity to design interventions to improve the process a...

The 2019 Town Hall gathers stakeholders in the human factors and ergonomics (HFE) community who share an interest in applying HFE to study and improve patient work, an area called “patient ergonomics.” The objective of this town hall is to communally scope, prioritize, and develop applications of HFE for patient work. Whereas the 2018 Town Hall was...

The growing field of patient ergonomics is built on an understanding that patients and their social network members increasingly play a key role in managing their health and healthcare across a wide range of settings including the home, workplace, and community. Over the last several years, we have traced, explored, and debated emerging research in...

Patient ergonomics is the application of human factors or related disciplines to study and improve patients' and other non-professionals' performance of effortful work activities in pursuit of health goals. We performed a mapping review of 212 full-text patient ergonomics publications in two conference proceedings, 2007-2017. The review revealed a...

Patients and families play a role in the safety of care provided across clinical settings, highlighting the need to understand clinician perspectives and experiences related to their engagement. Through a panel discussion entitled, The Patient in Patient Safety: Clinicians’ Experiences Engaging Patients as Partners in Safety, we elicited clinician...

Heart failure (HF) is a complex chronic illness that affects the older adult population, requiring medical therapy and day-to-day management to prevent worsening and exacerbation. Patients with HF are often treated with cardiac implanted electronic devices (CIEDs) which capture diagnostic and predictive parameters for HF. In this work we explore ho...

Valid design of patient-centered digital health or health information technology (IT) systems is based on a thorough and accurate understanding of both “user reality” and “clinical reality.” Type 1 Design Error (User-Reality Error) occurs when designers do not accommodate user characteristics, tasks, context of use, needs, or preferences. Type 2 De...

Health promotion is defined by the World Health Organization as “the process of enabling people to increase control over their health and its determinants, and thereby improve their health.” This is different from the bulk of formal healthcare processes, which are characterized by the treatment of an established disease. Much important human factor...

Patients with heart failure (HF) are commonly implanted with cardiac resynchronization therapy (CRT) devices as part of their treatment. Presently, they cannot directly access the remote monitoring (RM) data generated from these devices, representing a missed opportunity for increased knowledge and engagement in care. However, electronic health dat...

Objectives: To explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. Design: Cross-sectional qualitative interview study. Setting: PICU in a large Midwestern tertiary-care children's hospital. Subjects: Parents of patients in a PICU (n = 33). Mea...

A central paradigm in the current era of health and healthcare is the centrality of patients, families, and community members in their own health. Patients and other nonprofessionals are increasingly recognized as working independently or in concert with healthcare professionals in an effort to achieve health-related goals. This patient work has be...

Older adults with chronic heart failure (CHF) make daily decisions to manage their disease, with some of these decisions resulting in major health outcomes such as acute decompensation, hospitalization, and death. To understand how older adults with CHF make these decisions in their natural sociotechnical system context, we analyzed data from criti...

In the early stages of the design process, designers often benefit from the use of personas, or archetypes of target users presented in a vivid way to highlight design-relevant characteristics. In the growing efforts to create health information technology (HIT) for older adults, empirically derived personas could help orchestrate more user-centere...

Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patien...

Background and Objectives: Managing complex medication regimens is difficult health-related work for older adults living with chronic illnesses. A new area of research is the application of tools and technologies to improve health-related work performance and prevent outcomes such as medication nonadherence, errors, and worsening health. Usable too...

Objective To explore perceptions of critical care providers about a novel collaborative inpatient health information technology (HIT) in a pediatric intensive care unit (PICU) setting. Methods This cross-sectional, concurrent mixed methods study was conducted in the PICU of a large midwestern children’s hospital. The technology, the Large Customiz...

Background: Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at ri...

Through a variety of activities, patients take active roles in their health, which may directly or indirectly influence safety and quality. We provide brief overviews of perspectives from researchers and practitioners conducting work on patient-centered topics to highlight the need for awareness and research on the role of the patient and informal...

An important domain of patient safety is the management of medications in home and community settings by patients and their caregiving network. This study applied human factors/ergonomics theories and methods to data about medication adherence collected from 61 patients with heart failure accompanied by 31 informal caregivers living in the US. Seve...

Background: Barriers in heart failure self-care contribute to heart failure hospitalizations, but geographic differences have not been well-studied. We aimed to compare self-care barriers in heart failure patients managed at tertiary centers in an Eastern (Singapore) versus a Western (USA) nation. Methods: Acute heart failure patients were prosp...