Primary care clinics play a vital role in the US healthcare system, providing preventative and cost-effective care. New trends in healthcare such as the development of the medical home model for care, the application of electronic medical records (EMRs), the effort to increase access to care, and the need to adhere to the Health Insurance Portability and Accountability Act (HIPAA) will have direct impacts on the work flow and spatial delineation of primary care clinics. To ensure the success of primary care practices, the architectural design of primary care clinics needs to address these changes to satisfy both patients and staff, and to improve efficiency and outcomes of care. There is limited literature on the design usability (efficiency, effectiveness, and user satisfaction) of primary care clinics. This study developed a set of building usability evaluation tools to collect, analyze and interpret the “usability” of a primary care facility. The study used previous literature as well as a case study primary care clinic in Maryland as a basis to develop these tools. In the clinic, data were collected through an initial interview with the head nurse, a forty-hour behavioral observation, and a staff survey. A behavioral observation tool and a survey questionnaire were developed for the data collection. For data analysis, JMP Pro 9 software was used to analyze the data collected through behavioral observation and the staff survey. The literature review developed a “Building Usability Framework” specifically for healthcare design. A data analysis tool, the “Usability Matrix” was created to integrate and understand the analyzed data within the Building Usability Framework. Integrating the analyzed data from the case study within the Usability Matrix, a primary care clinic usability evaluation survey was developed at the end of the study. This survey along with the behavioral observation tool and design analysis tools were compiled together to produce the “Building Usability Evaluation Tool-Kit for Primary Care Clinics.” This tool-kit can be used by architects and researchers interested in designing and analyzing “usable” primary care clinics.

abstract: Overview: Transition from the pediatric to adult care setting for 'emerging adults' (ages 18- 26) continues to develop as a growing concern in health care. The Adolescent Transition Program teaches chronically ill 'emerging adults' disease self-management skills while promoting a healthy lifestyle. Transferring this knowledge is vital for successful health care outcomes. Unfortunately, patients who have been transferred to the adult care setting, report that they felt lost in the system due to lack of communication between care teams, inadequate support systems, and insufficient disease management knowledge. To address these gaps, the design of the physical environment must adapt to these challenges while also meeting the needs of various chronic illnesses. Methodology: Design thinking or human-centered design was utilized as the vehicle to discover unmet 'emerging adult' and adolescent health clinician needs. Ethnographic research methods involved observations at adolescent health clinics and in learning environments outside of the healthcare setting as well as interviews with 5 outpatient adolescent clinicians. A survey was also conducted with 16 'emerging adults' to understand how they learn. Lastly, a literature review explored the history of the adolescent, adolescent development, adolescence and chronic illness, and The Adolescent Transition Program. Results: Findings revealed that physical environment must be conducive to meet a variety of clinical and education activities such as chronic disease management, support adolescent development, and should be more human-centered. The space should transform to the patient education or clinical activity rather than the activity transforming to the space. Five design recommendations were suggested to ensure that the outpatient clinic supported both clinician and 'emerging adults' needs. / Dissertation/Thesis / M.S.D. Design 2014