Quadruple Aim

Definition: Quadruple Aim is the expansion of the Triple Aim (enhancing patient experience, improving population health, and reducing costs) to include an additional goal of improving the work life of health care providers.¹ Organizations view this expansion in different ways, but the Institute for Healthcare Improvement calls this new aim “Joy in Work.”¹ Many health care organizations have adopted the framework of the Triple Aim, but the stressful work life of clinicians and staff has proven to play a large role in the ability to achieve and maintain the 3 aims. In primary care, the adoption of the Triple Aim has enhanced the patient experience, but resources are lacking to help providers and staff maintain these overarching goals. Professional burnout and reduced job satisfaction have hindered the ability of providers and staff to provide quality care.² Therefore, a fourth aim focusing on the improvement in work life of clinicians and staff has been proposed to create a more symbiotic relationship between patients and health care providers.

How it relates to ACO/PCMH: The Triple Aim is focused on improving patient care, and practices within PCMH and ACOs must continue pursuing the original 3 aims while expanding their focus to the Quadruple Aim.¹ Expansion of pharmacists’ roles can help support many aspects of the Quadruple Aim. Pharmacists can, under various collaborative care models, assume responsibility of chronic disease state management and preventive care in order to increase the efficiency of the care team, support value-based care, and have a clinical impact.³ Pharmacists can also play a role in quality-focused initiatives to support the system and providers’ efforts to improving the provided quality of care. The expansion of pharmacist roles within the care team can increase access to care while allowing pharmacists to practice at the top of their training.

Involved organizations/oversight: The expansion of the Triple Aim to the Quadruple Aim has been proposed to improve the work life of health care providers. Some organizations are using the Triple Aim, while others have adopted the Quadruple Aim. Regardless of the adoption of the Quadruple Aim by health care organizations, an emphasis on health care provider satisfaction remains a hot topic.

Resources:

1. Feeley D. The triple aim or the quadruple aim? Four points to help set your strategy. Institute for Healthcare Improvement website. 28 Nov 2017. Available at: www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy. Accessed October 9, 2019.
2. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014 Nov;12(6):573-576. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC4226781/
3. Stefanacci RG. Targeting the quadruple aim through clinical pathways. J Clin Pathways. 2018;4(2):33-35. Available at: www.journalofclinicalpathways.com/article/targeting-quadruple-aim-through-clinical-pathways

Contributing authors:

Ashley Huntsberry, PharmD, BCACP

Sara Wettergreen, PharmD, BCACP
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences

Last Updated 11/25/2019