Chesca Colloredo-MansfeldStrategic Advisor (USA)
Q & A with MiracleFeet Co-founder and CEO Chesca Colloredo-Mansfeld
Our mobile data collection app, CAST, is transforming how we gather and use real-time data worldwide and amplifying our focus on treatment precision and program quality. By partnering with Dimagi, MiracleFeet developed an offline-capable and mobile-optimized solution that allows us to follow patient progress, improve clinic management, and monitor and evaluate the quality of treatment around the world.
We completed the global rollout of the CommCare-based system in early 2020, and I recently sat down with Dimagi’s team to talk about the difference this technology is making in our work with medical partners now using the tool in 30 countries.
What is the main objective of CAST?
To achieve our long-term goal of reaching and treating at least 70% of children born with clubfoot each year, we knew our systems needed to evolve. We needed a streamlined data collection tool to support and track patient progress across our growing global network of clinics and providers, who are increasing access to this critical treatment.
In implementing CAST, our main objective was to make it easier for our partners around the world to contribute routine patient-level data, which we use to continuously assess quality. And we wanted to ensure that data would be accessible to them—to all partners and providers in 30 countries—not just to program managers in North Carolina. We also wanted the tool to make their jobs easier, not create extra work.
How has CAST changed the way MiracleFeet approaches service delivery?
The ability to enter data in an app and have real-time access to relevant information has transformed how MiracleFeet works with local partners. CAST has improved our service delivery in three key ways:
Tracking Patient Dropouts: Addressing patient dropout is one of the most challenging aspects of our work. The ability to quickly and easily follow up with patients who miss appointments or relapsed in treatment is an incredible improvement.
Improving Outcomes: CAST improves treatment outcomes by helping us track key indicators, like tenotomy rates, for example. This minor surgical procedure is a key component of clubfoot treatment yet sometimes providers skip it because they aren’t trained in or comfortable with the technique. Through CAST data, we can see where tenotomy rates are low and design trainings or campaigns to ensure providers consistently include this critical step.
Informing Interventions: Data from CAST also gives our partners a roadmap to increase access to care where gaps exist. It helps us determine where to prioritize new treatment locations based on where patients live and where current clinic volumes are higher than birth estimates predict. Additionally, we can pull clinic-level reports on patient age at the beginning care, which tells us where additional early-identification training and awareness activities are needed so children begin treatment as infants, not in the toddler years or later.
CommCare provides a highly intuitive platform that’s easy for providers to use and directly benefits their day-today clinic management. For providers, it works as an electronic medical record (EMR) and patient management and communication system, allowing them to collect key data at the time of treatment that MiracleFeet needs to ensure quality and plan for growth.
What impact has CAST had on MiracleFeet’s frontline workers? What was their response to the platform?
In a single mobile-friendly application, providers can review patient history, prepare for daily patient volumes, review missed appointments, and follow up with caretakers to reschedule visits.
CAST’s suite of features informs our efforts to increase early detection and referral rates, raise community awareness, and provide parent support and education. For example, if partners and clinicians see that adherence to treatment is lower than MiracleFeet’s targets, they can introduce new interventions. Atypical cases can also be tagged through guided prompts, which help providers diagnose patients needing special attention.
Overall, allowing providers to join in tracking the progress and results of children they’re treating is a critical feature that makes CAST so successful within our network. The data is useful to them and their clinical work and incentivizes quality care.
How has MiracleFeet had to adapt program approaches due to COVID-19?
Our actions in response to COVID-19 are different in every country. Having real-time data allowed us to identify patterns and see which countries—and which clinics—were slowing down and which were completely suspending treatment. This daily information was key to our response and support strategy for each program.
Having detailed information about clinics in Tanzania, for instance, revealed that most were not shutting down, so we needed to reallocate funds to provide PPE for clinic staff and families. In Guatemala, clinics were completely closed, so the team was able to shift focus to address the highest priority needs of the community: providing food and supplies to the most vulnerable patient families.
From the clinic coordinator side, CAST was a key communication tool. If clinics were closed, staff could see which patients were scheduled for what type of appointment and send SMS messages or make phone calls to parents to provide information and support – such as guiding them through stretching exercises and things they could do at home to support treatment while waiting for clinics to reopen.
As we design recovery efforts and plans to address the backlog of cases, having weekly patient data enables us to know the exact number of children whose treatment was delayed or interrupted, and how many have resumed care. One of the main metrics that we are closely tracking is the number of recovered patients in each country; we hope to get 80% of patients back whose care was interrupted. Without CAST, MiracleFeet would lack the data and communication tools to reach and recover these patients in an efficient and effective way.
Lastly, having real time data about what was happening in every clinic gave our board and our donors incredible confidence that we knew what was happening in detail and were making informed decisions about how best to proceed.
When MiracleFeet implemented CAST, there was no way to predict the various and unintended applications created by the global pandemic. In the very first year of global use, CAST has been under trial by fire and has exceeded our expectations in the most trying circumstances.
What changes, if any, have you had to make to CAST because of the pandemic?
We added two features to CAST since the pandemic. We started tracking different treatment protocols, including home visits and remote education or teleconsultations, and we added a question on the intake form for new patients: “was your treatment delayed because of the pandemic?” One in five five families have responded “yes.” Knowing whose care was interrupted will be incredibly useful in reaching out to patients to prioritize care depending on age and stage of treatment.
CAST has transformed the way we work – but that doesn’t mean we’re done innovating. As an enterprising organization, we are constantly thinking about how to make our work more effective and efficient so we can reach more kids.
Part of why we love CAST is that we can see how much progress we are making on quality, but also it allows us to see how all our initiatives are working together. Our future success depends on continued innovation and our challenge now is to think expansively and creatively about ways to apply a core operational system, like CAST, to address the major challenges of scaling this treatment. Here are few of our biggest ideas:
What's next for CAST?
Brace compliance: Since the most common cause of clubfoot relapse is poor brace compliance, using a brace sensor that sends data to CAST will allow us to determine when braces are not being used as prescribed. Knowing this, we can proactively reach out to parents to provide support and information about the importance of wearing the brace every night for several years. There are two prototypes currently in development, supported by pro bono teams in India and the UK.
Early identification and referral: We’re investigating the feasibility of a component of the app that midwives and frontline healthcare workers can use to identify children born with clubfoot at birth—perhaps an integration with other prenatal and newborn screening tools–then MiracleFeet partners could pro-actively follow up with families.
Tracking equipment and inventory: Tracking brace inventory and other treatment supplies (casting materials, etc.) in CAST could improve supply chain efficiencies and ensure clinics have what they need without devoting significant time to inventorying supplies and communicating/anticipating upcoming needs. This is in the idea stage at the moment, but we are keen to investigate feasibility.
Two-way communication: Facilitating and tracking communication between providers and parents, and between parent groups, can greatly enhance patient support and long-term adherence. There are many tools that facilitate this type of communication and community-building so we’re optimistic about the possibilities.
Doctor-to-doctor communication: If a provider encounters a difficult or unusual case, they could consult other doctors who have experiences treating similar cases. This communication is already taking place to some extent, but centralizing it within CAST would make it easier for providers working in remote places to access the global expertise of other physiotherapists and orthopedic surgeons.
Telemedicine: Providing video consultations when possible to patients would help increase efficiency and aid in overcoming some treatment barriers such as transportation hurdles. Thanks to COVID, these consults are being utilized more frequently but again, centralizing and enabling this capability within the app would make it that much easier for providers.