Triple Aim Is Triply Tough: Can You Focus on Three Things at Once?

Area of Science:

• Health Services Research
• Quality Improvement
• Primary Care Medicine

Background:

• The I3 POP Collaborative aimed to enhance patient health in North Carolina, South Carolina, and Virginia primary care teaching practices.
• The initiative focused on the triple aim framework: better quality, appropriate utilization, and improved patient experience.

Purpose of the Study:

• To examine changes in triple aim measures over a three-year period within participating primary care teaching practices.
• To identify factors associated with successful improvement in quality, utilization, and patient experience.

Main Methods:

• Twenty-nine teaching practices from 23 residency programs participated, utilizing the Institute for Health Care Improvement Breakthrough Series Collaborative model.
• Data were collected annually on quality (chronic illness, prevention), utilization (hospitalizations, ED visits, referrals), and patient experience (access, continuity).
• Participant interviews were conducted to explore supports and barriers to improvement.

Main Results:

• Six practices (21%) could not extract measures from electronic health records (EHR).
• Of the remaining 23 practices, all reported improvement in at least one measure; seven (24%) improved measures across all three triple aim areas.
• Practices with higher patient visit volume showed greater likelihood of improvement (OR 10.8, P=0.03), with engaged leadership and system supports correlating with higher performance.

Conclusions:

• Simultaneously achieving all triple aim goals in teaching practices presents significant challenges.
• Practices capable of data extraction and reporting demonstrated improvement in at least one measure.
• Future efforts should prioritize fostering leadership and systems that facilitate large-scale quality improvement.