Tanner J Caverly1,2,3,4, Sarah E Skurla5, Mandi L Klamerus5, Jordan B Sparks5, Eve A Kerr5,6,7, Timothy P Hofer5,6,7, David Reed8, Laura J Damschroder5. 1. Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA. tcaverly@med.umich.edu. 2. Institute for Health Policy Innovation, University of Michigan School of Medicine, Ann Arbor, MI, USA. tcaverly@med.umich.edu. 3. Department of Learning Health Sciences, University of Michigan School of Medicine, Ann Arbor, MI, USA. tcaverly@med.umich.edu. 4. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. tcaverly@med.umich.edu. 5. Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA. 6. Institute for Health Policy Innovation, University of Michigan School of Medicine, Ann Arbor, MI, USA. 7. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 8. Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI, USA.
Abstract
INTRODUCTION: Engaging patients and frontline clinicians in re-designing clinical care is essential for improving care delivery in a complex clinical environment. This study sought to assess an innovative user-centered design approach to improving clinical care quality, focusing on the use cases of de-intensifying non-beneficial care within the following areas: (1) de-intensifying diabetes treatment in high-risk patients; (2) stopping screening for carotid artery stenosis in asymptomatic patients; and (3) stopping colorectal cancer screening in average-risk, older adults. METHODS: The user-centered design approach, consisting of patient and patient-clinician charrettes (defined as intensive workshops where key stakeholders collaborate to develop creative solutions to a specific problem) and participant surveys, has been described previously. Following the charrettes, we used inductive coding to identify and categorize themes emerging from the de-intensification ideas prioritized by participants as well as facilitator notes and audio recordings from the charrettes. RESULTS: Thirty-five patients participated in the patient design charrettes, generating 134 unique de-intensification ideas and prioritizing 32, which were then distilled into six patient-generated principles of de-intensification by the study team. These principles provided a starting point for a subsequent patient-clinician charrette. In this follow-up charrette, 9 patients who had participated in an earlier patient design charrette collaborated with 7 clinicians to generate 63 potential de-intensification solutions. Six of these potential solutions were developed into multi-faceted, fully operationalized de-intensification strategies. DISCUSSION: The de-intensification strategies that patients and clinicians prioritized and operationalized during the co-design charrette process were detailed and multi-faceted. Each component of a strategy had a rationale based on feasibility, practical considerations, and ways of overcoming barriers. The charrette-based process may be a useful way to engage clinicians and patients in developing the complex and multi-faceted strategies needed to improve care delivery.
INTRODUCTION: Engaging patients and frontline clinicians in re-designing clinical care is essential for improving care delivery in a complex clinical environment. This study sought to assess an innovative user-centered design approach to improving clinical care quality, focusing on the use cases of de-intensifying non-beneficial care within the following areas: (1) de-intensifying diabetes treatment in high-risk patients; (2) stopping screening for carotid artery stenosis in asymptomatic patients; and (3) stopping colorectal cancer screening in average-risk, older adults. METHODS: The user-centered design approach, consisting of patient and patient-clinician charrettes (defined as intensive workshops where key stakeholders collaborate to develop creative solutions to a specific problem) and participant surveys, has been described previously. Following the charrettes, we used inductive coding to identify and categorize themes emerging from the de-intensification ideas prioritized by participants as well as facilitator notes and audio recordings from the charrettes. RESULTS: Thirty-five patients participated in the patient design charrettes, generating 134 unique de-intensification ideas and prioritizing 32, which were then distilled into six patient-generated principles of de-intensification by the study team. These principles provided a starting point for a subsequent patient-clinician charrette. In this follow-up charrette, 9 patients who had participated in an earlier patient design charrette collaborated with 7 clinicians to generate 63 potential de-intensification solutions. Six of these potential solutions were developed into multi-faceted, fully operationalized de-intensification strategies. DISCUSSION: The de-intensification strategies that patients and clinicians prioritized and operationalized during the co-design charrette process were detailed and multi-faceted. Each component of a strategy had a rationale based on feasibility, practical considerations, and ways of overcoming barriers. The charrette-based process may be a useful way to engage clinicians and patients in developing the complex and multi-faceted strategies needed to improve care delivery.
Authors: Lisa S Rotenstein; Matthew Torre; Marco A Ramos; Rachael C Rosales; Constance Guille; Srijan Sen; Douglas A Mata Journal: JAMA Date: 2018-09-18 Impact factor: 56.272
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Authors: Shari S Rogal; Vera Yakovchenko; Thomas J Waltz; Byron J Powell; Rachel Gonzalez; Angela Park; Maggie Chartier; David Ross; Timothy R Morgan; JoAnn E Kirchner; Enola K Proctor; Matthew J Chinman Journal: Implement Sci Date: 2019-04-08 Impact factor: 7.327
Authors: Mandi L Klamerus; Laura J Damschroder; Jordan B Sparks; Sarah E Skurla; Eve A Kerr; Timothy P Hofer; Tanner J Caverly Journal: JMIR Res Protoc Date: 2019-11-26
Authors: Daniel J Morgan; Shannon Brownlee; Aaron L Leppin; Nancy Kressin; Sanket S Dhruva; Les Levin; Bruce E Landon; Mark A Zezza; Harald Schmidt; Vikas Saini; Adam G Elshaug Journal: BMJ Date: 2015-08-25
Authors: Laura J Damschroder; Andrew J Knighton; Emily Griese; Sarah M Greene; Paula Lozano; Amy M Kilbourne; Diana S M Buist; Karen Crotty; A Rani Elwy; Lee A Fleisher; Ralph Gonzales; Amy G Huebschmann; Heather M Limper; NithyaPriya S Ramalingam; Katherine Wilemon; P Michael Ho; Christian D Helfrichfcr Journal: Healthc (Amst) Date: 2021-06