Evidence-Based Practice and the Quadruple Aim – Assignment 1 Solution

Evidence-Based Practice and the Quadruple Aim

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions. 

• Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery. 

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

• Patient experience
• Population health
• Costs
• Work life of healthcare providers 

Solution

Relation between EBP and the Quadruple Aim

The relation between Evidence-based practice (EBP) and Quadruple Aim has been studied widely, and the evidence is overwhelming (Melnyk & Fineout-Overholt, 2019). EBP encompasses using best research evidence and incorporating patients and their families when delivering healthcare services (Crabtree et al., 2016). Moreover, EBP embraces interprofessional collaborations essential for effective clinical decision-making.  

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On the other hand, the Quadruple Aim is a health care improvement framework adapted from Triple Aim in 2014 to optimize healthcare system performance (Bodenheimer & Sinsky, 2014). Quadruple Aim encompasses the crucial aspects of universal and affordable health care delivery such as reduced costs, improved population health, improved patient experience, and improved wellbeing of healthcare providers.

EBP promotes the vital facets of Quadruple Aim, i.e., enhances care quality, patient outcomes, minimizes health care costs, and supports clinicians. The purpose of this paper is to discuss the impact of EBP on Quadruple Aim facets, including patient experience, population health, healthcare costs, and the wellbeing of healthcare providers.

Patient Experience

Patient experience is a vital healthcare component and includes patients’ views on interactions across the health care system, including health care plans, relationships with doctors, and nurses (Agency for Healthcare Research and Quality (AHRQ), 2021). EBP involves using literature search skills, evaluation, and translation of peer-reviewed research findings into clinical practice (Jacobs et al., 2018). As such, healthcare personnel attached to patients rely on tested evidence to inform diagnosis and treatment interventions depending on the patient’s condition.

Furthermore, EBP involves the incorporation of patients’ preferences, needs, and values into care decisions (Li, Cao & Zhu, 2019). As such, clinicians develop a good rapport with patients and their families through trust and respectful interaction, crucial to a positive patient experience. Critical to the personnel-patient relationship is the EBP promotion of easy access to information, good communication, and timely appointments by healthcare personnel.

This relationship allows health personnel to evaluate patient experiences and other components such as the safety and effectiveness of care from the patient’s perspective. Although the US still experiences poor care outcomes such as poor care excellence, lack of compassion, frustrations, and mortality (Boller, 2017), EBP supports positive patient experiences with the healthcare system required by the Quadruple Aim framework.

Population Health

The CDC regards population health as a multidisciplinary approach by health departments to integrate practice to policy to allow local changes (CDC, 2020). Critical to this interaction is applying EBP to achieve positive health outcomes in communities. Through EBP, significant health concerns are brought into focus and addressed through collaboration between academia and practice. According to Boller (2017), coordination of care involving patients and partners is an EBP strategy crucial in bridging the Quadruple Aim gaps in achieving optimum population health outcomes.

Critical to the role of EBP impact on population health is patient satisfaction, i.e., meeting patient expectations (AHRQ, 2021), through enhanced quality and safety of healthcare services. EBPs are vital in limiting medication errors, dictating roles of healthcare personnel, guiding diagnosis and treatment interventions, and decision-making.

A critical role of healthcare personnel is to promote and advocate for healthcare education to patients and communities on health determinants, patient conditions, benefits and risks of particular treatments, and the impact of cultural practices on patients’ health.  As of 2017, the USA had achieved a 15% decline in infant mortality due to effective population health interventions supported by EBP.

Common conditions hospital-acquired conditions such as pressure ulcers, urinary tract infections (UTIs), central line-associated bloodstream infections (CLABSIs), and patient falls have considerably declined due to the implementation of EBPs.  According to Sakallaris et al. (2016), integrating EBP in population health awareness contributes to equitable health resources. These milestones could be attributed to community health assessments, health screening, education, and identification of health priorities through scientific research and the application of tools to facilitate improved population health outcomes.

Costs

Healthcare is a significant challenge for patients and health providers in the US. Cost determines the quality of care, and higher costs are associated with better healthcare quality. Nevertheless, EBP reduces the cost of care by minimizing medical errors, which is a third leading cause of death in the USA and contributes to healthcare complications and associated direct medical costs (Melnyk & Fineout-Overholt, 2019).

However, the US still grapples with the need to reduce cost per capita despite the impact of the Patient Protection and Affordable Care Act (ACA). Challenges such as rising ACA costs, living costs, and access to affordable insurance impair US strategies to lower healthcare costs.

Moreover, EBPs improve the effectiveness of healthcare organizations. According to Lavenberg et al. (2019), EBPs are scientifically tested and proven methodologies, contributing to positive patient outcomes and experiences with the healthcare system. Equally, EBP improves the efficiency of nursing processes through medical and technological advancements. Therefore, systematic implementation of EBP reduces operation costs and improves definitive interventions, patient outcomes, and healthcare safety.

Work-life of healthcare providers

EBPs encompass collaboration among healthcare works. EBPs involve collaboration across healthcare settings in search of and critically appraise evidence to solve healthcare issues or establish practice guidelines (Melnyk & Fineout-Overholt, 2019). Search outcomes and an appraisal are shared with colleagues and partners across various mediums to improve healthcare material availability and access.

Collaboration in healthcare settings is crucial in promoting the wellbeing of health care personnel by minimizing workload, chronic frustrations, and enhancing mental health (Williams & Wilhoit, 2016). EBP practices guidelines establish work environments that support healthcare providers, encourage shared decision-making, and improve productivity.

Conclusion

EBP is a vital healthcare concept that encompasses the application of available best evidence for patient care. EBP also incorporates patients’ and their families’ values, needs, and preferences in decision-making and encourages collaboration among healthcare teams. Therefore, EBP plays a crucial role in achieving Quadruple Aim by supporting and guiding healthcare providers in a healthcare organization in achieving its facets.

References

Agency for Healthcare Research and Quality. (Reviewed June 2021). What is Patient Experience? Agency for Healthcare Research and Quality, Rockville, MD. Available at: https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html (Accessed 2 December 2021)

Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple Aim: care of the patient requires care of the provider. The Annals of Family Medicine, 12(6), 573-576.  https://doi.org/10.1370/afm.1713

Boller, J. (2017). Nurse Educators: Leading Health Care to the Quadruple Aim Sweet Spot. https://doi.org/10.3928/01484834-20171120-01

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving Patient Care Through Nursing Engagement in Evidence‐Based Practice. Worldviews on Evidence‐Based Nursing, 13(2), 172-175. https://doi.org/10.1111/wvn.12126

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in wellbeing: moving from the triple Aim to the quadruple Aim. Nursing administration quarterly, 42(3), 231-245 Assignment: Evidence-Based Practice and the Quadruple Aim sample essay. https://doi.org/10.1097/naq.0000000000000303

Li, S., Cao, M., & Zhu, X. (2019). Evidence-based practice: Knowledge, attitudes, implementation, facilitators, and barriers among community nurses—a systematic review. Medicine, 98(39). https://dx.doi.org/10.1097%2FMD.0000000000017209

Melnyk, B. M., & Fineout-Overholt, E. (Eds.). (2019). Evidence-based practice in nursing & healthcare: A guide to best practice. Lippincott Williams & Wilkins.

Sakallaris, B. R., Miller, W. L., Saper, R., Jo Kreitzer, M., & Jonas, W. (2016). Meeting the challenge of a more person-centered future for US healthcare. Global advances in health and medicine, 5(1), 51-60. https://doi.org/10.7453%2Fgahmj.2015.085

The Centers for Disease Control and Prevention. (Updated October 2020). Population Health Training: What is Population Health? Available at: https://www.cdc.gov/pophealthtraining/whatis.html (Accessed 2 December 2021)

William Jackson Epperson MD, M. B. A., FACMPE, S. F. C., & Wilhoit, G. (2016). Provider burnout and patient engagement: the quadruple and quintuple aims. The Journal of medical practice management: MPM, 31(6), 359. http://evohcc.com/wp-content/uploads/2018/10/May_Jun_2016_359-363.pdf