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Applying User-Centered Design to Develop Practical Strategies that Address Overuse in Primary Care



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.


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.


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.


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.

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This study was funded by the Department of Veterans Affairs Health Services Research and Development IIR 15-131. Dr. Caverly is supported by a career development award from the VA HSR&D (CDA 16-151).

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Correspondence to Tanner J. Caverly MD, MPH.

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Conflict of Interest

Dr. Caverly, Ms. Skurla, Ms. Klamerus, and Ms. Damschroder have nothing to disclose; Ms. Sparks and Mr. Reed report grants from Department of Veterans Affairs, during the conduct of the study; Dr. Hofer reports grants from VA HSR&D, during the conduct of the study; Dr. Kerr reports grants from VA HSR&D, during the conduct of the study; past personal fees from BIND as a member of the Clinical Advisory Board, outside the submitted work; and Dr. Kerr serves on the Advisory Board for the NIH-funded US Deprescribing Network.

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Prior Presentation:

This data was previously presented at the 2019 Academy Health Annual Research Meeting.

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Caverly, T.J., Skurla, S.E., Klamerus, M.L. et al. Applying User-Centered Design to Develop Practical Strategies that Address Overuse in Primary Care. J GEN INTERN MED (2021).

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  • user-centered design
  • Veterans
  • overuse
  • de-intensification