The Quintuple Aim for Health Care Improvement

Nundy, Shantanu; Cooper, Lisa A.; Mate, Kedar S.

doi:10.1001/jama.2021.25181

Cited by 387 publications

(239 citation statements)

References 8 publications

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“…Documenting these issues is necessary, especially in light of the Quintuple Aim’s latest dimension, health equity. 23 …”

Section: Discussionmentioning

confidence: 99%

“…Although health equity is part of the Quintuple Aim for Health Care Improvement framework, access to PHC is unevenly distributed across the population. 23 According to the 2016 Commonwealth Fund International Health Policy Survey of Adults, lower income, immigrant status and mental health issues were consistently found to be associated with experiencing access barriers to primary care. 24 Regarding CWLs more specifically, the introduction of guidelines and policies aiming to prioritise vulnerable populations has not prevented inequities in wait times to attachment.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol

et al. 2023

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IntroductionAttachment to a primary care provider is an important component of primary care as it facilitates access. In Québec, Canada, attachment to a family physician is a concern. To address unattached patients’ barriers to accessing primary care, the Ministry of Health and Social Services mandated Québec’s 18 administrative regions to implement single points of access for unattached patients (Guichets d’accès première ligne(GAPs)) that aim to better orient patients towards the most appropriate services to meet their needs. The objectives of this study are to (1) analyse the implementation of GAPs, (2) measure the effects of GAPs on performance indicators and (3) assess unattached patients’ experiences of navigation, access and service utilisation.Methods and analysisA longitudinal mixed-methods case study design will be conducted. Objective 1. Implementation will be analysed through semistructured interviews with key stakeholders, observations of key meetings and document analysis. Objective 2. GAP effects on indicators will be measured using performance dashboards produced using clinical and administrative data. Objective 3. Unattached patients’ experiences will be assessed using a self-administered electronic questionnaire. Findings for each case will be interpreted and presented using a joint display, a visual tool for integrating qualitative and quantitative data. Intercase analyses will be conducted highlighting the similarities and differences across cases.Ethics and disseminationThis study is funded by the Canadian Institutes of Health Research (# 475314) and the Fonds de Soutien à l’innovation en santé et en services sociaux (# 5-2-01) and was approved by the CISSS de la Montérégie-Centre Ethics Committee (MP-04-2023-716).

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“…Documenting these issues is necessary, especially in light of the Quintuple Aim’s latest dimension, health equity. 23 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol

et al. 2023

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“…Given the current orientation of health systems toward delivering integrated and coordinated health and community services (68, 69), this systematic review is also highly relevant to policy makers. We identi ed system navigation models that may support outcomes relevant to the Quintuple Aim framework for healthcare improvement (70,71), which is top of mind for decision makers to advance health equity and improve patient and provider experiences, health system utilization, and cost-effectiveness. Our ndings highlight the potential bene t of team-based system navigation as a strategy to improve use of primary healthcare services versus costlier healthcare (e.g., emergency department visits, hospitalizations) and enhance patient experiences with care.…”

Section: Implications For Policymentioning

confidence: 99%

Effectiveness of System Navigation Programs Linking Primary Care with Community-Based Health and Social Services: A Systematic Review

Teggart

Neil-Sztramko

Nadarajah

et al. 2023

Preprint

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Background Fragmented delivery of health and social services can impact access to high-quality, person-centred care. The goal of system navigation is to reduce barriers to healthcare access and improve the quality of care. However, the effectiveness of system navigation remains largely unknown. This systematic review aims to identify the effectiveness of system navigation programs linking primary care with community-based health and social services to improve patient, caregiver, and health system outcomes. Methods Building on a previous scoping review, PsychInfo, EMBASE, CINAHL, MEDLINE, and Cochrane Clinical Trials Registry were searched for intervention studies published between January 2013 and August 2020. Eligible studies included system navigation or social prescription programs for adults, based in primary care settings. Two independent reviewers completed study selection, critical appraisal, and data extraction. Results Twenty-one studies were included; studies had generally low to moderate risk of bias. System navigation models were lay person-led (n = 10), health professional-led (n = 4), team-based (n = 6), or self-navigation with lay support as needed (n = 1). Evidence from three studies (low risk of bias) suggests that team-based system navigation may result in slightly more appropriate health service utilization compared to baseline or usual care. Evidence from four studies (moderate risk of bias) suggests that either lay person-led or health professional-led system navigation models may improve patient experiences with quality of care compared to usual care. It is unclear whether system navigation models may improve patient-related outcomes (e.g., health-related quality of life, health behaviours). The evidence is very uncertain about the effect of system navigation programs on caregiver, cost-related, or social care outcomes. Conclusions There is variation in findings across system navigation models linking primary care with community-based health and social services. Team-based system navigation may result in slight improvements in health service utilization. Further research is needed to determine the effects on caregiver and cost-related outcomes.

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“…Countries with better health outcomes are acknowledged for success, whereas those with lower-ranked health outcomes seek to close the gap on their deficits. In the US and elsewhere, inequity gaps in health have been widely recognized …”

mentioning

confidence: 99%

“…In the US and elsewhere, inequity gaps in health have been widely recognized. 1,2 The research enterprise has yet to accumulate much knowledge about inequitable diagnosis. For instance, the percentage of life-years that could be saved from more equitable diagnostic excellence has not been estimated.…”

mentioning

confidence: 99%

Achieving Equity in Diagnostic Excellence

McDonald

2022

JAMA

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Inequitiesinhealthandhealthcare arecommon.Worldwide, metrics track infant mortality, life expectancy, patient safety, and quality of care. Countries with better health outcomes are acknowledged for success, whereas those with lower-ranked health outcomes seek to close the gap on their deficits. In the US and elsewhere, inequity gaps in health have been widely recognized. 1,2 The research enterprise has yet to accumulate much knowledge about inequitable diagnosis. For instance, the percentage of life-years that could be saved from more equitable diagnostic excellence has not been estimated. The contribution of suboptimal diagnostic approaches to the morbidity and mortality experienced by those with inequitable outcomes has not been analyzed. These data gaps limit current understanding of the determinants and consequences of diagnostic inequities.Achieving equity in diagnostic excellence needs to consider multiple perspectives. Systems thinking can set the stage for areas of potential improvement, for actionable knowledge about diagnostic inequities that originate within or outside the medical system, and for actionable knowledge about coordination across system boundaries.

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The Quintuple Aim for Health Care Improvement

Abstract: This Viewpoint proposes expanding the quadruple aim (improving population health, enhancing the care experience, reducing costs, and addressing clinician burnout) to the quintuple aim, adding a fifth aim of advancing health equity.

Cited by 387 publications

References 8 publications

Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol

Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol

Effectiveness of System Navigation Programs Linking Primary Care with Community-Based Health and Social Services: A Systematic Review

Achieving Equity in Diagnostic Excellence

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