The Triple Aim: Care, Health, And Cost

Berwick, Donald M.; Nolan, Thomas; Whittington, John

doi:10.1377/hlthaff.27.3.759

Cited by 4,263 publications

(2,904 citation statements)

References 13 publications

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“…In the current climate of healthcare reform, lower costs of care offer a tremendous competitive advantage to hospitals. There is a constant and increasing pressure on the US healthcare system to reduce costs of care, and hospitals are increasingly challenged to deliver higher‐quality care at lower costs 27, 33. Alternative payment models require that hospitals assume both financial and performance accountability for the care of their patients undergoing PCI.…”

Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

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Section: Discussionmentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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“…A SHE curriculum developed from within the framework of social accountability provides a critical scaffold for students and teachers to understand the importance of what is learned to the healthcare needs of the patients they serve. Moreover, a SHE curriculum resonates with aims [18] for bettering the healthcare system by (1) improving population health through proactive anticipation of society’s healthcare needs and attention to prevention, and (2) reducing healthcare costs by focusing on the sustainability and resource efficiency (including containment of waste and cost) in the healthcare system [5]. …”

Section: Introductionmentioning

confidence: 99%

Identification of core objectives for teaching sustainable healthcare education

Teherani

Nishimura

Apatira

et al. 2017

Medical Education Online

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Background: Physicians will be called upon to care for patients who bear the burden of disease from the impact of climate change and ecologically irresponsible practices which harm ecosystems and contribute to climate change. However, physicians must recognize the connection between the climate, ecosystems, sustainability, and health and their responsibility and capacity in changing the status quo. Sustainable healthcare education (SHE), defined as education about the impact of climate change and ecosystem alterations on health and the impact of the healthcare industry on the aforementioned, is vital to prevention of adverse health outcomes due to the changing climate and environment. Objective: To systematically determine which and when a set of SHE objectives should be included in the medical education continuum. Design: Fifty-two SHE experts participated in a two-part modified-Delphi study. A survey was developed based on 21 SHE objectives. Respondents rated the importance of each objective and when each objective should be taught. Descriptive statistics and an item-level content validity index (CVI) were used to analyze data. Results: Fifteen of the objectives achieved a content validity index of 78% or greater. The remaining objectives had content validity indices between 58% and 77%. The preclinical years of medical school were rated as the optimal time for introducing 13 and the clinical years for introducing six of the objectives. Respondents noted the definition of environmental sustainability should be learned prior to medical school and identifying ways to improve the environmental sustainability of health systems in post-graduate training. Conclusions: This study proposes SHE objectives for the continuum of medical education. These objectives ensure the identity of the physician includes the requisite awareness and competence to care for patients who experience the impact of climate and environment on health and advocate for sustainability of the health systems in which they work. Abbreviations: CVI: Content validity index; SHE: Sustainable healthcare education

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“…In some ways, the ultimate promise of digital technology is not the ability to deliver or manage care remotely but the ability to better customize the entire interaction between the patient and the health care system. Such customization could facilitate leaps forward in our ability to improve health, to enhance the patient experience, and to reduce cost [22,23]. Table 2 gives examples for each of these goals and how analytics can help patients like Jeremy.…”

Section: What Can Be Done To Rectify Digital Injustice?mentioning

confidence: 99%

Why Aren't Our Digital Solutions Working for Everyone?

Winkle

Carpenter

Moscucci

2017

AMA Journal of Ethics

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The article explores a digital injustice that is occurring across the country: that digital solutions intended to increase health care access and quality often neglect those that need them most. It further shows that when it comes to digital innovation, health care professionals and technology companies rarely have any incentives to focus on underserved populations. Nevertheless, we argue that the technologies that are leaving these communities behind are the same ones that can best support them. The key is in leveraging these technologies with: (a) design features that accommodate various levels of technological proficiency (eliteracy), (b) tech-enabled community health workers and navigators who can function as liaisons between patients and clinicians, and (c) analytics and customer relationship management tools that enable health care professionals and support networks to provide the right interventions to the right patients. Finally, we argue that community health care workers will need to be incentivized to play a larger role in building and adopting innovations targeting the underserved. Narrative: Heart Failure and the Failure of Remote Monitoring Jeremy lives in a small subsidized housing development with his mother and three sisters. At 52, he struggles with heart failure with reduced ejection fraction. This year alone, he has visited the emergency department four separate times. Luckily, a nearby hospital has recently been focusing on reducing readmission rates for heart failure in response to increasing incentives related to value-based care. The hospital is exploring promising technologies that might help Jeremy: inexpensive remote monitoring devices that are connected wirelessly to a broadband router through Bluetooth ® . The solutions require Jeremy to use a scale and arm blood pressure cuff to record daily metrics that are sent wirelessly to his cardiologist. The idea is that, if clinicians can monitor Jeremy on a real-time basis, they can evaluate his health to see if he is deteriorating or stable. They can then use this information to proactively schedule an appointment or to make a medication adjustment. The solution, like many designed to prevent costly emergency visits or readmissions postdischarge, is considered to be integral in bending the cost curve and improving health. The problem is that none of these solutions are working. Jeremy is only becoming sicker and more frustrated. He lives in a home where wireless

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The Triple Aim: Care, Health, And Cost

Cited by 4,263 publications

References 13 publications

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Identification of core objectives for teaching sustainable healthcare education

Why Aren't Our Digital Solutions Working for Everyone?

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