Improving the value of healthcare systems using the Triple Aim framework: A systematic literature review

The notion of value-based healthcare has become increasingly important for healthcare institutions, and more and more countries are adopting its representative approach-namely, the US Institute for Healthcare Improvement's Triple Aim framework for optimizing health system performance in terms of population health, patient experience, and cost of care. In this study, using a five-step systematic review protocol and PRISMA methods we systematically review and analyze with descriptive and qualitative analysis methods literature on the results of using the Triple Aim framework for assessment at the health system level, especially the concept of balance among the framework's goals. Inclusion criteria were that the paper evaluated the policy-level impact of value-based healthcare movements based on the Triple Aim goals, discussing at least one of the goals or the balance. Our analysis shows a lack of consensus on the impact of each goal and on the concept of a balance between the goals, and a paucity of literature related to the pursuit of the Triple Aim at the health system level. To properly evaluate the impact of the value-based healthcare movement, a standard set of measures aligned with the context is needed. The results of this study are expected to contribute to the improved assessment of health system performance, development of the Triple Aim framework's measures, and ultimately, enhanced effectiveness in achieving healthcare goals.