Saturday, April 20, 2024

The Quadruple Aim in Healthcare: Exploring the Viability of Integrating Hospital Specialists into Primary Care

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The Quadruple Aim of improving population health, enhancing patient care experience, reducing costs, and boosting professional satisfaction can be achieved by reorganizing healthcare. Integrating healthcare services on various levels is seen as a viable way to achieve this aim. A systematic review has been conducted to evaluate the cost-effectiveness of incorporating hospital specialists into primary care from the perspectives of commissioners, patients, and professionals.

The research followed the PRISMA guidelines, utilizing databases such as PubMed, Scopus, and EBSCO for the period of 1992-2022. Out of the 4254 articles found, 21 original articles that reported on both quality and costs were included. The JBI and ROBINS-I tools were used for quality appraisal, and vote counting and effect direction plots were used for data synthesis, alongside a sign test. The GRADE was used to evaluate the strength of evidence.

Quadruple Aim

Cost, Quality, and Patient Perspectives for The Quadruple Aim

The results indicated that cost-effectiveness was only measured in two studies, and it remains unclear. However, costs and cost drivers for commissioners were lower in the intervention in 52% of the studies; this proportion rose to 67% of the studies when cost for patients was also considered. Health outcomes, patient experience, and professional satisfaction mostly improved or at least remained the same. Costs for the patient, where measured, were mainly lower in the intervention group. Professional satisfaction was reported in 48% of the studies; in 80% it was higher in the intervention group.

In 24% of the studies, higher monetary costs were reported for commissioners, whereas the clinical outcomes, patient experience, and costs for the patient mainly improved. The cost-effectiveness of the hospital specialist in the primary care model remains inconclusive. Only a few studies have comprehensively calculated costs, evaluating cost drivers. However, it seems that when the service is well organized and the population is large enough, the concept can be profitable for the commissioner also.

From the patient’s perspective, the model is superior and could even promote equity through improved access. Professional satisfaction is mostly higher compared to the traditional model. The certainty of evidence for the Quadruple Aim is very low for cost and low for quality. The study has been registered with PROSPERO under the number CRD42022325232.


Original Article DOI: 10.1186/s12913-023-10159-6

Original title: Evidence on bringing specialised care to the primary level-effects on the Quadruple Aim and cost-effectiveness: a systematic review

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