Cory Rogers, PharmD Candidate 2023, University of Mississippi School of Pharmacy
The Institute for Healthcare Improvement (IHI) is a not-for-profit organization promoting health improvement by advancing the quality and value of healthcare in America. Recent events, including Covid-19 and provider burnout, have expanded the IHI Triple Aim to a Quintuple Aim. The goal of the Triple Aim was to articulate in an efficient way the aims of healthcare. The goals they proposed were to improve the population’s health, enhance the patient’s experience, and reduce healthcare costs.1
Figure 1: Diagram of the Quintuple Aim 2
It was in 2014, that a fourth aim was added to address the issue of healthcare provider burnout. Therefore, workforce well-being and safety became a new component of the aims. Hospitals and other healthcare facilities were losing employees and found that the environment didn’t support overall well-being well enough. Earlier this year, the idea of advancing healthcare equity was proposed as a fifth aim. This introduced what is now called the Quintuple Aim.
Improving population health is looking at the observable outcomes such as whether a patient received the best possible quality of care. We look at things like whether a patient died or not, how often is the patient being readmitted for the same diagnosis, is a patient’s blood pressure controlled, etc. The patient experience is a much more subjective parameter that is self-reported. We can ask questions about the pain he/she may be experiencing, whether the communication provided was acceptable, or even to see if they feel respected by the providers and the staff. To reduce healthcare costs, we have to look for efficacy improvements. New healthcare technologies are being developed every day but with that comes a labor and financial cost. This requires optimally using our resources to provide the best care. Care team well-being has brought about things like mindfulness and meditation activities and other personal/professional development initiatives.
It has been shown across the country that groups of people who have been socially marginalized including racial and ethnic minority groups, the elderly, the disabled, and those in poverty have all experienced higher rates of COVID-19.4 These individuals face greater morbidity and mortality from infection and receive less preventative and chronic care. This has propelled the idea of expanding to the Quintuple Aim, to create equity for all people and particularly those who are the most vulnerable.
In the latest JAMA Viewpoint article, the authors discussed how to address health inequities.5 The following steps were listed:
Identify the disparities in our communities.
Design and implement evidence-based interventions to reduce them.
Invest in equity measurement, meaning we determine whether the care being provided is equitable or not.
Incentivize the achievement of healthcare equity.
Sites that are in network with Dispensary of Hope have a great opportunity to implement each of these steps in their local communities. Your partnership is helping to provide health equity by providing healthcare access to those who are not eligible for other assistance and allowing individuals to receive medications free of charge. A great way to measure the equity being provided is to gather data regarding race, gender, language, income, geographical location, and other parameters. Another measure would be to look at social needs such as housing stability and food security. The recent study completed earlier this year with Research Triangle Institute (RTI) International and Dispensary of Hope helped to show that there is a significant incentive by reducing healthcare costs and preventing further rehospitalizations as shown below.6
Figure 2: Results of the 2022 Study Completed by RTI International and DOH 5
Health inequities are affecting people every day and create a great disparity for those individuals. Quality improvement efforts without health equity will lead to limited progress. Sites that are in the Dispensary of Hope network help provide health equity by improving medication access for the most vulnerable and underserved patient populations. These individuals often face many social determinants of health barriers including: lack of income, insurance status, geographical location, provider accessibility, and citizenship status. A partnership with Dispensary of Hope equips clinics and pharmacies to intentionally participate in all five of the Quintuple Aims and ultimately improve healthcare across America.
Triple aim for populations: IHI. Institute for Healthcare Improvement. https://www.ihi.org/Topics/TripleAim/Pages/default.aspx. Accessed September 9, 2022.
PricewaterhouseCoopers. Building a healthcare system that's fit for purpose. PwC. https://www.pwc.com/ca/en/industries/healthcare/system-fit-for-purpose.html. Accessed September 12, 2022.
Risk for COVID-19 infection, hospitalization, and death by Race/Ethnicity. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Accessed September 12, 2022.
Nundy S, Cooper LA, Mate KS. The quintuple aim for Health Care Improvement. JAMA. 2022;327(6):521. doi:10.1001/jama.2021.25181
2022 study reveals better health outcomes and significant cost savings. 2022 STUDY Reveals Better Health Outcomes and Significant Cost Savings. https://www.dispensaryofhope.org/news/posts/2022-study-reveals-better-health-outcomes-and-significant-cost-savings. Accessed September 16, 2022.