What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level

Mery, Gustavo; Majumder, Shilpi; Brown, A Cassandra Dove; Dobrow, Mark

doi:10.1016/j.healthpol.2017.03.014

Cited by 36 publications

(38 citation statements)

References 18 publications

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“…Children with MCCs compose a high-risk patient population in which significant improvement is needed in all dimensions of the Institute of Healthcare Improvement Triple Aim. 23 To better understand the natural history of MCCs in children, we sought to describe the first temporal trends and epidemiological profile of MCCs in children living in a mixed urban-rural community. We found that both the prevalence and the incidence of MCCs among children living in Olmsted County, Minnesota, have increased during the 15-year study period, and MCCs are more prevalent among children with a low SES and minority background.…”

Section: Discussionmentioning

confidence: 99%

“…3 Therefore, addressing the needs of children with MCCs and improving their outcomes while containing costs are national and local research priorities. 22,23 Despite the burden of MCCs on children, families, communities, and health care systems, the epidemiological assessment of children with MCCs within a geographically defined pediatric US population has not been previously performed. Although valuable, the extant literature is limited to cohorts derived from databases originating from health care use,* payer source, 4,[7][8][9][10]14,20,[30][31][32][33] death certificates, [34][35][36][37] and national surveys.…”

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confidence: 99%

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Epidemiology of Children With Multiple Complex Chronic Conditions in a Mixed Urban-Rural US Community

Bjur

Ryu

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Children with multiple complex chronic conditions (MCCs) represent a small fraction of our communities but a disproportionate amount of health care cost and mortality. Because the temporal trends of children with MCCs within a geographically well-defined US pediatric population has not been previously assessed, health care planning and policy for this vulnerable population is limited. METHODS:In this population-based, repeated cross-sectional study, we identified and enrolled all eligible children residing in Olmsted County, Minnesota, through the Rochester Epidemiology Project, a medical record linkage system of Olmsted County residents. The pediatric complex chronic conditions classification system version 2 was used to identify children with MCCs. Five-year period prevalence and incidence rates were calculated during the study period (1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) and characterized by age, sex, ethnicity, and socioeconomic status (SES) by using the housing-based index of socioeconomic status, a validated individual housing-based SES index. Age-, sex-, and ethnicity-adjusted prevalence and incidence rates were calculated, adjusting to the 2010 US total pediatric population. RESULTS:Five-year prevalence and incidence rates of children with MCCs in Olmsted County increased from 1200 to 1938 per 100 000 persons and from 256 to 335 per 100 000 person-years, respectively, during the study period. MCCs tend to be slightly more prevalent among children with a lower SES and with a racial minority background. CONCLUSIONS:Both 5-year prevalence and incidence rates of children with MCCs have significantly increased over time, and health disparities are present among these children. The clinical and financial outcomes of children with MCCs need to be assessed for formulating suitable health care planning given limited resources.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Epidemiology of Children With Multiple Complex Chronic Conditions in a Mixed Urban-Rural US Community

Bjur

Ryu

et al. 2019

Hospital Pediatrics

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“…To what degree these factors impact the ability of collaborations to achieve all four Q-Aims is a question for future research, particularly in relation to population health and equity given concerns raised by PH advocates. More recently, Q-Aim proponents are coming to terms with the concept of equity as fundamental to all constructs of the framework [40]. Application of an equity lens, most often claimed within a population health approach, pushes health systems to consider: how to make health care services accessible to marginalized populations within the context of universalism; how and whom to fund to deliver these services; how to support those best able to deliver these services; and how to share responsibilities with other sectors in an upstream, population health model recognizing broader determinants of health [23].…”

Section: Discussionmentioning

confidence: 99%

Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies

et al. 2020

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Background: Health systems in Canada and elsewhere are at a crossroads of reform in response to rising economic and societal pressures. The Quadruple Aim advocates for: improving patient experience, reducing cost, advancing population health and improving the provider experience. It is at the forefront of Canadian reform debates aimed to improve a complex and often-fragmented health care system. Concurrently, collaboration between primary care and public health has been the focus of current research, looking for integrated community-based primary health care models that best suit the health needs of communities and address health equity. This study aimed to explore the nature of Canadian primary care-public health collaborations, their aims, motivations, activities, collaboration barriers and enablers, and perceived outcomes. Methods: Ten case studies were conducted in three provinces (Nova Scotia, Ontario, and British Columbia) to elucidate experiences of primary care and public health collaboration in different settings, contexts, populations and forms. Data sources included a survey using the Partnership Self-Assessment Tool, focus groups, and document analysis. This provided an opportunity to explore how primary care and public health collaboration could serve in transforming community-based primary health care with the potential to address the Quadruple Aims. Results: Aims of collaborations included: provider capacity building, regional vaccine/immunization management, community-based health promotion programming, and, outreach to increase access to care. Common precipitators were having a shared vision and/or community concern. Barriers and enablers differed among cases. Perceived barriers included ineffective communication processes, inadequate time for collaboration, geographic challenges, lack of resources, and varying organizational goals and mandates. Enablers included clear goals, trusting and inclusive relationships, role clarity, strong leadership, strong coordination and communication, and optimal use of resources. Cases achieved outcomes addressing the Q-Aims such as improving access to services, addressing population health through outreach to at-risk populations, reducing costs through efficiencies, and improving provider experience through capacity building.

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“…The Triple Aim (Berwick, Nolan, & Whittington, 2008), initially proposed as a structure for organizational and local healthcare improvement, has since become a strategic framework for improved health care globally (Mery, Majumder, Brown, & Dobrow, 2017). The original three aims were to improve the patient experience, improve health, and reduce cost.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Transforming Care to Evidence‐Based Practice With Scripted Messages: An Improvement Project for Pain Management in Outpatient Surgical Patients

Bellury

Mullinax

Mozingo

et al. 2018

Worldviews Ev Based Nurs

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A scripted message showed statistical significance and a small clinical effect in pain control that adds to the body of knowledge around the effectiveness of scripting delivered by nurses. Although it is encouraging that even the small dose of scripting had a significant effect on postoperative pain control, the feasibility issues around similar study designs will require considerable resources to surmount. Practice change is a complex process requiring sensitivity to work and patient flow especially in specialty care units. Resistance to change when evidence is not robust may be especially difficult related to scripting, often perceived as a mandated intrusion into the nurse-patient relationship.

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What do we mean when we talk about the Triple Aim? A systematic review of evolving definitions and adaptations of the framework at the health system level

Cited by 36 publications

References 18 publications

Epidemiology of Children With Multiple Complex Chronic Conditions in a Mixed Urban-Rural US Community

Epidemiology of Children With Multiple Complex Chronic Conditions in a Mixed Urban-Rural US Community

Addressing quadruple aims through primary care and public health collaboration: ten Canadian case studies

Transforming Care to Evidence‐Based Practice With Scripted Messages: An Improvement Project for Pain Management in Outpatient Surgical Patients

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