Medicaid equity simulation project
The UCSIM | Center for Simulations & Virtual Environments Research (UCSIM) designed and developed a virtual reality patient simulation experience for Medicaid providers delivered via a fully immersive head-mounted-display (HMD) virtual reality system. For each case study, the user has the ability to navigate around the scene and interact with the environment in virtual reality. Informational data overlays include patient charts, medical information, and appropriate interface elements for conversing with and evaluating the patient. The user’s responses are recorded and reported for feedback at the conclusion of the virtual reality experience.
In response to a call from the Ohio Colleges of Medicine Government Resource Center and the Medicaid Technical Assistance and Policy Program, the UC College of Nursing and College of Medicine worked with the Center for Simulations and Virtual Environments Research (UCSIM) to develop two patient care VR simulations focusing on social health determinants of health. A number of community partners, such as Talbert House, Crossroads, and Lincoln Heights Health Center will serve as test sites for the simulations. UC is collaborating with Ohio State University to deliver the simulations regionally.
UC College of Nursing
PI: Dr. Susan Brammer
Asst. Professor - Educator
UCSIM Project Lead
Chris M. Collins, Sr. IT Manager
UCSIM | Center for Simulations & Virtual Environments Research
Ohio Colleges of Medicine Government Resource Center (GRC)
Case Study 1: No Show – This 20-minute VR module will engage the Medicaid provider in a pre-office visit scenario that immerses the participant into the patient’s life experience in a typical day preparing to leave home for a primary care office visit. Multi-sensory feedback will be incorporated to optimally impact empathy and cognition.
This module will feature Mr. or Ms. S, depending on the participant, a Spanish speaking 75-year-old retired shop owner from Puerto Rico with limited English proficiency. The patient is a dually eligible Medicare/Medicaid beneficiary. The patient/participant suffers from osteoarthritis that has resulted in a severe limp, depression, poorly controlled HTN and Type 2 DM. The participant will experience the daily challenges Mr./Ms. S faces with social isolation, limited English proficiency, inadequate and unsafe housing, neighborhood violence and lack of access to transportation that contribute to failing health, primary health care access and a preventable ED visit.
In the second part of the module, the participant as the primary care provider, will be asked to prioritize the social determinants of health depicted in the scenario. The provider will receive feedback, options and resources, to help support this patient’s identified health related social needs including alternative visit options to the traditional office visit to help mitigate this patient’s risk for poor health outcomes and preventable utilization.
Case Study 2: Schizophrenia Assessment & Treatment Plan – This 20-minute VR module will allow the Medicaid provider to experience not only the challenges faced by community mental health care professionals, but the many factors that a person with schizophrenia must face beyond the symptoms of his or her illness. Symptoms such as paranoid delusions and auditory hallucinations can be disabling. Perhaps even more damaging, however, are the social and environmental sequelae of the disease. The goal of this VR simulation is to increase providers’ awareness and understanding of the social determinants of health that have a negative impact on a person’s ability to achieve wellness.
Mental health providers don’t always appreciate the multi-faceted struggles faced by their patients with schizophrenia and may have difficulty empathizing with them. Providers may feel overwhelmed once they recognize the tremendous need for support, in ways that may be beyond their skill set. This VR simulation takes the Medicaid provider through a visit with a patient with schizophrenia. The provider will conduct an assessment of the patient and recommend a plan of care. In addition, the provider will spend time in the world of the patient and discover the tenuous nature of his housing, the challenges created by poverty, and the lack of access to care.
The patient, Mr. J., is a 22-year-old, single, unemployed African American male with comorbid diagnoses of schizophrenia and asthma. Mr. J. has recently been discharged from an inpatient psychiatric unit where he was treated for an acute psychotic episode. He has been referred to the community mental health clinic for follow-up care.