From Co-Design to Quality Improvement: Using the Double Diamond Framework to Develop Primary Care Redesign Priorities...

Despite evidence supporting clinic-community linked hypertension interventions for socially disadvantaged populations, sustaining these interventions in real-world primary care has been challenging. The objective of this work was to identify shared potential priorities for redesigning hypertension care using a structured Double Diamond co-design framework across health systems and community-based organizations (CBOs) serving census tracts with a high prevalence of hypertension.

We used the Double-Diamond design strategy to co-create hypertension care redesign priorities with four diverse health systems and multiple CBOs from our target census tracts. We established two co-design working groups: one for data and evaluation elements, and one for community engagement and health equity elements. Fourteen structured co-design meetings followed the Double Diamond phases (discover, define, develop, deliver) to identify needs and refine priorities. We used thematic analysis and triangulated findings from meeting summaries, fieldwork observations, existing community health needs assessments and geospatial data assessments of the priority census tracts to identify shared priorities for quality improvement (QI) efforts across health systems.

Our target census tracts had greater socioeconomic disadvantages compared to surrounding tracts. Stakeholders identified actionable redesign priorities, including improving data usability and standardizing data across health systems; incorporating the lived experiences of patients; enhancing interoperability and the real-time availability of CBO resources; and fostering cross-system team-based care and collaboration.

A multi-component Double-Diamond design approach facilitated the development of primary care redesign priorities grounded in the reality of health systems and CBOs and offers a practical pathway for transitioning from co-design to measurable QI efforts.

Community members and representatives from community-based organizations (CBOs) were involved throughout the co-design process as partners rather than as research participants. Community members and CBO representatives participated in the community engagement working group, contributed to fieldwork in high-priority census tracts, and helped interpret findings from community health needs assessments and geospatial analyses to identify locally relevant priorities. Their lived experience informed the development of quality improvement (QI) priorities for clinic-community linked hypertension care. Stakeholder input focused on system-level design considerations, rather than individual clinical encounters and will continue through a patient advocacy team composed of individuals living with hypertension from the target neighbourhoods to guide subsequent QI efforts. Coauthor Marquita Rockamore is a community member who leads a community health worker training programme at a local community college and serves as the chair of the steering committee for this work.