TRIPLE (or Quadruple) AIM

A New Course for Providing Improved Healthcare

In 2007, Dr. Don Berwick of the Institute for Health Improvement, based in Cambridge, charted a new course for providing healthcare in this country.  He proposed a conceptual framework that is designed to improve the patient’s care experience, while at the same time reduce the cost of care and attend to improved health of populations of people. Simply called the Triple Aim, it calls for a strategic focus on all three dimensions at once.  There has been no time previously that healthcare in the United States has been focused on all three domains at one time. A radical idea at first, the Triple Aim has now entered the mainstream and many healthcare organizations have adopted its tenets.

Organizations and communities that, in fact, attain the Triple Aim (or come close to it) have healthier populations to care for, have better coordinated care, and reduce the per capita cost of care.

Health centers specifically have been initiating systems change projects to implement this new framework.  With a focus on primary and preventive care, health centers must consider the health care needs of the populations of people they serve and how to improve the quality of services provided.  To do this many HCs have invested in expensive electronic medical record (EMR) systems that when leveraged with health information technology (IT) can maximize this investment along with achieving better care, shrewder spending, and healthier people. More specifically, health centers can use their EMR systems to achieve these goals by:

• Measuring and reporting results of per capita cost, experience of care, and health status of designated populations of people; and
  • Using that information to systematically determine where to focus resources to improve outcomes.
• Some examples might be to identify patients who need cancer screenings or to identify patients who have not been seen in the last 6 months who have elevated blood levels and reach out to them to schedule appointments.

There is recent discussion of expanding the Triple Aim to the Quadruple Aim, which incorporates the important aspect of improving the work life of clinicians and staff. As the authors of ‘From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider’ note, the Triple Aim has provided society with a compass, pointing the way forward for our health care system. The positive engagement, rather than the negative frustration, of the health care workforce is of paramount importance in achieving the primary goal of the Triple Aim—improving population health.

When implemented and used fully, EMR and other Health IT systems can support health centers and their staff in their work to optimize their organizations and achieve the Triple (or Quadruple) Aim.