UT to develop training tool to better care for patients who are homeless

February 20, 2019 | News, Research, UToday, Health and Human Services, Medicine and Life Sciences, UTMC
By Tyrel Linkhorn



The University of Toledo is developing a virtual reality training to improve Ohio Medicaid providers’ cultural competency and reduce implicit bias as a way to better understand the patients they serve. The virtual reality training focuses on the barriers to health care faced by those without stable, permanent housing.

UT faculty from the College of Medicine and Life Sciences and the College of Health and Human Services will conduct interviews and observe interactions in an area homeless shelter to build a realistic portrait of the health-care struggles experienced by individuals who depend on urban homeless shelters for their housing.

A multidisciplinary team from UT is building a virtual reality training program to help Ohio Medicaid providers better treat patients without stable, permanent housing. The investigators are, from left, Dr. Thomas Papadimos, medical director and associate dean for immersive and simulation-based learning; Dr. Shipra Singh, assistant professor of health education and public health; Dr. Lance Dworkin, professor and chair of medicine; and Dr. Scott Pappada, assistant professor of anesthesiology and bioengineering.

From that data, faculty and staff from the College of Medicine and Life Sciences, the School of Population Health in the College of Health and Human Services, and the Jacobs Interprofessional Immersive Simulation Center will create an interactive experience that will electronically place clinicians into a model homeless shelter as fly-on-the-wall observers.

“There’s a lot of attention nowadays to how one’s background and social structure impact not only their health, but also how successful they are in using the health-care system,” said Dr. Lance Dworkin, professor and chair of the UT Department of Medicine, and the primary investigator for the project. “If we understand that, we can integrate that knowledge into the care we provide so it’s more effective.”

The University also is building a robust evaluation component into the program that will monitor physical biomarkers such as heart rate, blood pressure and respiratory rate while participants are engaged in the simulation. Using assessment software developed by Dr. Scott Pappada, UT assistant professor of anesthesiology and bioengineering, and a co-investigator on the project, researchers will collect data before and after the simulation to learn how the program affects clinicians and whether it helps them connect with individuals who are marginalized by society.

The project is funded by a $1.24 million grant from the Ohio Department of Medicaid.

UT’s work is part of a larger partnership between the Ohio Department of Medicaid and Ohio’s medical schools, administered by the Ohio Colleges of Medicine Government Resource Center. Like many projects managed by the center, the Medicaid equity simulation project is aimed at reducing health disparities, addressing the social determinants of health, and improving patient care and health outcomes for Ohio’s Medicaid population.

During the course of the homeless shelter simulation, health-care providers will see rudimentary sleeping quarters, dining and social areas, observe the interactions between guests and staff, and listen in on conversations gleaned from the real-life interviews.

“The big message here is how does one change clinical decision making based on what is learned about an individual in this environment,” said Dr. Shipra Singh, UT assistant professor of health education and public health, and a co-investigator on the project.

Singh, who is directing the scripts that will be used in the simulation, said those changes could be as simple as not forcing someone who has no access to reliable transportation to go to the back of the line if they’re late for an appointment, or understanding that immediate lifestyle changes may not be possible.

“You need to listen to the patient rather than just look at them and understand the cultural context they’re coming from and what really matters to them,” Singh said.

The program is expected to be ready to launch to Ohio Medicaid providers within The University of Toledo Medical Center in May and disseminated throughout the community by June.