Mapping Patient Journeys in Drug Addiction Treatment Challenge

Challenge Summary:

The National Institute on Drug Abuse (NIDA), one of the components of the National Institutes of Health (NIH), is announcing the “Mapping Patient Journeys in Drug Addiction Treatment” Challenge. The Challenge goal is to inspire the creation of actionable patient journey maps that might further the understanding of the obstacles that patients face in getting treatment for drug addiction, particularly while our country is in the middle of an ongoing opioid crisis. NIDA invites participants to identify specific points during the patient journey where patients encounter the most difficulty, enabling NIDA to focus new research efforts into alleviating those areas of difficulty in patients’ drug addiction treatment journeys.

The Challenge will offer up to three awards for first, second, and third place entries of $50,000, $30,000, and $20,000 each, respectively. The Challenge total purse is up to $100,000.

Subject of the Challenge:

Many health systems, doctors, biomedical researchers, and governments are doing their best to help patients become more engaged in their health. Patients who are informed about their condition and involved in their treatment decisions generally have better health outcomes and incur lower costs.  But what do patients really want? What does their patient journey look like? Is their patient journey more treacherous when it comes to finding treatment for drug addiction?

In the United States, over 20 million people have drug or alcohol addiction – that’s one in seven people. Half of the U.S. population knows someone who has previously had or currently has a drug or alcohol addiction. The medical term for a drug addiction is a substance use disorder (SUD). Patients are diagnosed with a specific type of disorder based on the primary substance that they misuse, such as an opioid use disorder, stimulant use disorder, cannabis use disorder, or sedative, hypnotic, or anxiolytic use disorder. SUD is a complex but treatable condition. If untreated, it gets worse over time. Doctors determine the severity level of the SUD to help develop the best treatment plan. The higher the severity, the more intensive the level of treatment needed. Most SUD patients are likely to need ongoing treatment and recovery support using a chronic care model for several years. That is, their patient journey will continue for a long time.

What is a patient journey? A patient journey is the ongoing sequence of care events which a patient follows from the point of access into the health system, continuing towards diagnosis and care, and ending in outpatient care or recovery. It can be visualized as an ongoing interaction of care events occurring between the patients and healthcare providers. This journey can include many interconnected activities, ranging from the early education and awareness phase (for example, going online and searching for information about symptoms) to finding a clinic or provider, coming up with insurance or payment, interacting with a physician or other healthcare providers and, finally, appointment follow-ups and reminders for continued care. At the core of health care are the patients and the delivery of services that make them feel safe, comfortable, and ultimately result in improvements to their medical condition. However, for many SUD patients, the health care experience can be challenging, confusing, and inconsistent.

Traditionally, six phases of the patient journey are defined as follows:

1. Trigger Event/Awareness: The patients assess their own symptoms, conduct research, consider potential health conditions that may require treatment, and may even reach out to online communities (e.g., posing questions on social media);
2. Help: The patient makes initial contact with a health system, including health insurance, via call center, chat, email, mobile, or an in-person visit; 
3. Care: The patient is assessed at a medical facility (e.g., physician’s office, hospital);
4. Treatment:  The health system provides the patient with both on-site and follow-up care (e.g., prescriptions, physical therapy, counseling, or suggested lifestyle changes);
5. Behavioral/Lifestyle Change: The patient makes changes to daily routines and takes part in proactive healing in order to reduce readmissions and promote long-term wellbeing;
6. Ongoing Care/Proactive Health: The patient manages his or her care between clinical visits or admissions; meanwhile, the health system fosters engagement between the patient and physician in order to enable the patient to address symptoms and maintain good health.

Patient journeys are captured in the form of a map. Do you know why it is called a “journey map”? Customer journey mapping is a well-known technique that focuses on determining how customers interact with a particular business. Businesspeople traditionally use customer journey maps to define all of the customers’ steps and to create positive experiences, as this helps to ensure customer satisfaction and leads to repeat business and customer loyalty. Medical professionals are now applying these visual tools, which are so successfully used in business, to health care.  We all know that interacting with the health care system is not as simple as buying a carton of ice cream. Referral forms can go missing, medical office phone systems can be challenging to navigate to make an appointment, waiting times are extended, available beds are difficult to find, the disease or its treatments are long and painful, and most interactions are heightened by the sense of the unknown, fear, uncertainty, and, for SUD, stigma.

Visually mapping the journey allows any organization involved in providing health care to “see” and understand the patient experience by breaking down the management of a condition or treatment into a series of clear steps. These steps could be activities, interactions, or interventions that ultimately create the patient pathway or process of care. When all patient interactions with their healthcare are described as a map of the long treatment journey, that patient experience broadly highlights touchpoints with a healthcare system through the perspective of the real patients — what they think, feel, say, and do. The resulting visual tool incorporates both the physical and emotional journey with the aim of capturing patient obstacles, interactions, and movement through the health care system along with the patient behavior, feelings, motivations, and attitudes across the episodes of care. Journey maps go beyond the static and fixed view by illustrating the relationship between the patient and the healthcare organization as dynamic and changing within the system. They also help to visually convey knowledge and insights around patient experience and promote empathy towards patient groups by placing them at the heart of the healthcare delivery process. By issuing this Challenge, NIDA invites the SUD provider and patient communities to create patient journey maps to distill patient insights and emotions into a concise, visually compelling story of the patient’s experience. If you still have difficulties imagining what this visually compelling story could look like, the examples of traditional ways to visually map patient journeys could be found by simply searching “patient journey map” in your favorite search engine.

Given the complexity and high number of interdependencies that exist within SUD services, NIDA is eager to challenge the SUD provider and patient communities to design patient journey maps that are both comprehensive and accessible. If you are someone with access to, experience with, and knowledge of the SUD patient community, you are invited to create a patient journey map throughout SUD illness to recovery so that NIDA can better understand positive and negative patient interactions with the health system. Examples of the types of people NIDA is encouraging to participate include, but are not limited to: SUD patients, family members, patient advocates, academic researchers, pharmaceutical business development specialists, customer relations managers, marketing agencies, addiction group therapists, social workers from recovery centers, and medical school professors teaching students empathy and inclusion. As patient journey mapping is a way of visualizing and summarizing the service experiences that patients have over time, all from the perspective of the patient, it is very important to have access to the SUD patient population to be able to capture their specific experiences. NIDA is specifically interested in mapping a consecutive series of ‘touch points’ between the patient and SUD services where patient experience is actively shaped. This is because looking at this map enables an organization involved in healthcare, such as NIDA, to uncover the major “pain points”/”aha moments” (e.g. what the organization is doing poorly or that does not meet the patient’s expectations) and opportunities (e.g. what exactly could be done to improve/resolve the pains or create experiences that exceed patient expectation). Often, in patient journey mapping, those “pain points” and “aha moments” are collectively called “moments of truth” (gaps between the desired and the real experience). In turn, knowing and understanding each contact and gap can help the healthcare system to create strategic outcomes that improve SUD patient satisfaction and engagement. It will also help to better define where more targeted research efforts can or should occur, improving overall SUD care and outcomes.

How are the patients’ journeys usually created?  Participants (individually or in groups) are asked to split their stories into phases (these can be visualized as sections, chapters, or scenes) to help others understand how the journey changes. Between three and five phases is usually practical from a patient perspective, but it’s advisable to use as many phases as needed. Participants are then asked to describe their overall experience of each phase in more detail. Participants may start this by using a scale from one to ten to rate how satisfied SUD patients felt during each phase, followed by a prompt to describe feelings and emotions associated with each phase, noting these on the journey map. The map should highlight any especially good and bad service experiences in each phase. It is also helpful to analyze the values and actions that led to these positive and negative experiences, with an emphasis on the need to learn from both good and bad experiences. Next, the participants should be asked to think about improvement ideas and suggestions. These can be summarized on the journey map and detailed on separate sheets if more space is needed. If a group of patients contributes to the SUD patient journey mapping, you can take photos of the individual maps and develop a master version integrating all the different versions you have. Start your master map with the all-inclusive draft and then simplify it until key improvements are clearly contextualized in the journey phases and related experiences of patients. This final diagram commonly becomes a central reference for improvement teams and future work. It is important to make sure it is accurate, emotionally rich, and visually simple. Summarize your suggestions for specific improvement opportunities. While this describes a general outline for the patient journey mapping, NIDA challenges the community to be as creative as possible.

Partner:

• Foundation for the National Institutes of Health has supplied the funding for this Challenge. 

Dates:

• Challenge Launch: April 22, 2021
• Submission Start: April 22, 2021 12:00 AM ET
• Submission End: September 22, 2021 11:59 PM ET
• Judging Period: September 23, 2021 to October 14, 2021
• Winners Announced: October 25, 2021 

Statutory Authority to Conduct the Challenge

NIDA is conducting this Challenge under the America Creating Opportunities to Meaningfully Promote Excellence in Technology, Education, and Science (COMPETES) Reauthorization Act of 2010, as amended [15 U.S.C. § 3719]. The general purpose of NIDA is to conduct and support biomedical and behavioral research, health-services research, research training, and health-information dissemination with respect to the prevention of drug use and the treatment of drug addiction. As this Challenge is consistent with and advances the mission of NIDA as described in 42 U.S.C. 285o in that it seeks to identify intervention strategies to combat drug addiction, any submissions mapping patients’ experiences with alcohol use disorder will not be accepted. 

Prizes

Amount of the Prize:

The total prize purse is $100,000. NIDA may award first, second, and third place individual prizes of up to $50,000, $30,000, and $20,000, respectively, depending on the judges’ overall score. All meritorious submissions will be prominently featured on the NIDA website and via social media; additional opportunities to be profiled by NIDA may be developed in the future.

Award Approving Official:

The Award Approving Official will be the Director of NIDA.

Payment of the Prize:

Prizes awarded under this Challenge will be paid by electronic funds transfer and may be subject to Federal income taxes. NIH/NIDA will comply with the Internal Revenue Service withholding and reporting requirements, where applicable.

NIDA reserves the right, at its sole discretion, to (a) cancel, suspend, or modify the Challenge, and/or (b) not award any prizes if no entries are deemed worthy.

Rules

Eligibility Rules for Participating in the Challenge:

The Challenge is open to any participant(s) 18 years of age or older. A participant may be (i) an entity or (ii) an individual or (iii) a group of individuals (i.e., a team assembled with the purpose of participating in this Challenge).

1. To be eligible to win a prize under this Challenge, a Participant (whether an individual, group of individuals, or entity)
   1. Shall have registered to participate in the Challenge under the rules promulgated by NIDA as published in this announcement;
   2. Shall have complied with all the requirements set forth in this announcement;
   3. In the case of a private entity, shall be incorporated in and maintain a primary place of business in the United States, and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States. However, non-U.S. citizens and non-permanent residents can participate as a member of a team that otherwise satisfies the eligibility criteria. Non-U.S. citizens and non-permanent residents are not eligible to win a monetary prize (in whole or in part). Their participation as part of a winning team, if applicable, may be recognized when the results are announced;
   4. Shall not be a federal entity or federal employee acting within the scope of their employment;
   5. Shall not be an employee of the Department of Health and Human Services (HHS, or any other component of HHS) acting in their personal capacity;
   6. Who is employed by a federal agency or entity other than HHS (or any component of HHS), should consult with an agency Ethics Official to determine whether the Federal ethics rules will limit or prohibit the acceptance of a prize under this Challenge;
   7. Shall not be a judge of the Challenge, or any other party involved with the design, production, execution, or distribution of the Challenge or the immediate family of such a party (i.e., spouse, parent, step-parent, child, or step-child).
   8. Shall be 18 years of age or older at the time of submission.
2. Federal grantees may not use federal funds from a grant award to develop their Challenge submissions or to fund efforts in support of their Challenge submissions.
3. Federal contractors may not use federal funds from a contract to develop their Challenge submissions or to fund efforts in support of their Challenge submissions.
4. By participating in this Challenge, each Participant (whether an individual, group of individuals, or entity) agrees to assume any and all risks and waive claims against the federal government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from participation in this Challenge, whether the injury, death, damage, or loss arises through negligence or otherwise.
5. Based on the subject matter of the Challenge, the type of work that it will possibly require, as well as an analysis of the likelihood of any claims for death, bodily injury, property damage, or loss potentially resulting from Challenge participation, no Participant (whether an individual, group of individuals, or entity) participating in the Challenge is required to obtain liability insurance or demonstrate financial responsibility in order to participate in this Challenge.
6. By participating in this Challenge, each Participant (whether an individual, group of individuals, or entity) agrees to indemnify the federal government against third party claims for damages arising from or related to Challenge activities.
7. A Participant (whether an individual, group of individuals, or entity) shall not be deemed ineligible because the Participant used federal facilities or consulted with federal employees during the Challenge if the facilities and employees are made available to all Participants participating in the Challenge on an equitable basis.
8. By participating in this Challenge, each Participant (whether an individual, group of individuals, or entity) warrants that they are sole author or owner of, or has the right to use, any copyrightable works that the submission comprises, that the works are wholly original with the Participant (or is an improved version of an existing work that the Participant has sufficient rights to use and improve), and that the submission does not infringe any copyright or any other rights of any third party of which the Participant is aware.
9. By participating in this Challenge, each Participant (whether an individual, group of individuals, or entity) grants to the NIH an irrevocable, paid-up, royalty-free nonexclusive worldwide license to reproduce, publish, post, link to, share, and display publicly the submission on the web or elsewhere, and a nonexclusive, nontransferable, irrevocable, paid-up license to practice, or have practiced for or on its behalf, the solution throughout the world. Each Participant will retain all other intellectual property rights in their submissions, as applicable. To participate in the Challenge, each Participant must warrant that there are no legal obstacles to providing the above-referenced nonexclusive licenses of the Participant’s rights to the federal government. To receive an award, Participants will not be required to transfer their intellectual property rights to NIH, but Participants must grant to the federal government the nonexclusive licenses recited herein.
10. Each Participant (whether an individual, group of individuals, or entity) agrees to follow all applicable federal, state, and local laws, regulations, and policies.
11. Each Participant (whether an individual, group of individuals, or entity) participating in this Challenge must comply with all terms and conditions of these rules, and participation in this Challenge constitutes each such Participant’s full and unconditional agreement to abide by these rules. Winning is contingent upon fulfilling all requirements herein.

Disqualification:

Submissions may be disqualified for plagiarism, falsification of any information submitted, use of copyrighted material without permission, and use of profanity, violent images, or nudity. NIDA is not responsible for lost, late, incomplete, invalid, unintelligible, or misdirected entries, which will be disqualified. As this Challenge is consistent with and advances the mission of NIDA, in that it seeks to identify intervention strategies to combat drug addiction, submissions mapping patients’ experiences with alcohol use disorder will not be accepted.

Judging Criteria

Basis Upon Which a Winner Will be Selected

The judging panel, comprised of Department of Health and Human Services (HHS) scientists, will assess each submission’s creativity in depicting the patient journey map, generalizability of the journey to other patients struggling with a similar SUD, and clarity of the journey phases. The judges will consider the 4 following criteria and make recommendations to the award approving official based upon their assessments of the criteria. Each criterion will be scored with a maximum of 10 points.

1. Use of patient journey mapping elements (0-10 points). How well does the submission describe identification, selection, and characterization of the multiple patient journey phases and description of major touch points? To what extent does the submitted map identify, characterize, and capture the relevant symptoms, thoughts and emotions experienced by SUD patients along the journey? How well does the map illustrate the drivers and barriers for each segment of the journey? Does the map identify the “moments of truth” (gaps between the desired and the real experience)?
2. Creativity and originality (0-10 points). Does the submitted map convey a concise, visually compelling story of the SUD patient’s experience? Does the submission show quality composition, creativity, and aesthetics?
3. Applicability to broad patient population (0-10 points). Would others with a similar SUD make connections from this map to their own experiences? How well could the map reflect other patients’ journeys? Would the journey be applicable to patients of many different backgrounds (e.g., different genders, socioeconomic statuses, races/ethnicities, income levels)? How well does the patient journey map represent common emotions patients feel during their journey?
4. Clarity (0-10 points). Are the journey map and narrative clear and well-articulated? Are the labels for each step in the journey clear and concise? Is the journey presented in a straightforward manner? Is the patient journey map visually simple? Does it look like a map?

Submissions that are responsive and comply with the entry requirements will be reviewed by a panel of judges consisting of Federal employees. The responsive and compliant submission entries will be scored in accordance with the judging criteria outlined above. Scores from each criterion will be weighted equally, and the score for each submission will be the sum of the scores from each of the voting judges. The scores will be listed in order, from highest to lowest. Final prize recommendations will be determined based on the judges’ scoring. 

How to Enter

Participants may be an individual, a team of individuals, or an entity. Each team that enters the Challenge is required to identify a team leader who submits a solution on behalf of the team. Each entity that enters the Challenge is required to identify a point of contact who submits a solution on behalf of the entity. All submission materials must be emailed to NIDAChallenge@nih.gov with the subject line “Mapping Patient Journeys Challenge Submission” by the specified submission deadline date and time.

Submission Requirements:

Each submission for this Challenge requires a complete Submission Package. The Submission Package includes a Patient Journey Map depicting the steps a patient must take from the beginning of the drug addiction treatment journey to recovery and a written narrative describing the process the individual or team used to create the map (see requirements below). Both the map and the narrative will be evaluated.

1. Entry Form. Please complete and submit the entry form.
2. Patient Journey Map. The map must be a PDF or other image file and must be of high enough resolution to be legible/readable. All submissions must be in English. The participants must not use HHS’s logo or official seal or the logo of NIH or NIDA in the submissions and must not claim federal government endorsement. In the map:
   1. Clearly depict each step taken by a patient to get treatment for their substance use disorder.
   2. Identify the touch points between the patient and the healthcare system, paying specific attention to identifying the “moments of truth”, or the gaps between the desired and the real experience.
   3. Label all steps in the journey clearly and concisely.
   4. Be as creative as possible; you may use artistic media, graphic design, or anything else that comes to mind to create the map.
   5. Be safe and stop the spread of COVID-19! We encourage you to collaborate virtually wherever possible.
      **Please carefully read the Subject of the Challenge section. This will give you many pointers on how to create a winning map.
3. Narrative. A narrative describing the process that the individual or team used to create the Patient Journey Map must be submitted in PDF format and be no longer than 1,500 words (approximately 3 single-spaced pages; please use 11- or 12-point font). In the narrative:
   1. Outline how many people helped to construct the map. If multiple patients were surveyed or interviewed for their experiences, outline how many were surveyed/interviewed, along with which drug/substance they were seeking treatment for. (DO NOT provide any personally identifiable information (PII), including names, emails, dates of birth, or any other specific details.)
   2. Describe your methods and how you came up with the patient journey map and how all its touch points and “pain points” or obstacles were determined.

Additional Information

For Further Information Contact:

Challenge email: NIDAChallenge@nih.gov

Elena Koustova, PhD, MBA
NIDA Challenge Manager
Director, Office of Translational Initiatives and Program Innovations (OTIPI)
National Institute on Drug Abuse (NIDA)
Building 31 Room 1B47B
Bethesda, MD 20814
Phone: (301) 496-8768
Email: elena.koustova@nih.gov

Sara Lioi, PhD
NIDA Challenge Administrator
Office of Translational Initiatives and Program Innovations (OTIPI)
National Institute on Drug Abuse (NIDA)
Building 31 Room 1B59
Bethesda, MD 20814
Phone: (301) 827-5829
Email: sara.lioi@nih.gov

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