Viewpoint: Healthcare needs a 'quintuple aim'

The healthcare industry should expand the "quadruple aim" to include a fifth key focus: advancing health equity, three physician leaders wrote in a Jan. 21 op-ed published in JAMA.

The article's authors are:

  • Shantanu Nundy, MD, CMO of Accolade and a health policy lecturer at George Washington University Milken Institute School of Public Health in Washington, D.C.

  • Lisa Cooper, MD, Bloomberg Distinguished Professor at Johns Hopkins University School of Medicine and Bloomberg School of Public Health in Baltimore.

  • Kedar Mate, MD, president and CEO at the Institute for Healthcare Improvement, president of the IHI Lucian Leape Institute and a faculty member at Weill Cornell Medical College in New York City.

Quality and safety experts at the Institute for Healthcare Improvement first penned the term "triple aim," in 2006 to address a joint focus on improving population health, enhancing patient experience and lowering costs. This term evolved into the "quadruple aim" in 2014 to include a focus on addressing worker burnout. The op-ed's authors said the triple aim was expanded after  experts realized that quality improvement work would be unsustainable if healthcare facilities did not address burnout. 

"The reasoning for adding equity as a fifth aim is similar: Quality improvement without equity is a hollow victory," they wrote. "Quality improvement efforts without a focus on disparity reduction may have limited effects on health disparities and in fact unintentionally worsen them."

Addressing the "fifth aim" requires healthcare leaders to identify health disparities, implement evidence-based interventions to address them, measure progress and incentivize achievement of equity.

"Quality improvement efforts should be explicitly designed to improve health equity," they wrote.

Policymakers should also set health equity standards and provide effective economic support to help healthcare organizations achieve this work. 

View the full op-ed here.

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