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Abstract
Background The Alberta Health Services, Edmonton Zone Triple Aim Initiative launched in January, 2013. The seven participating clinical teams target complex, vulnerable patients in inner-city Edmonton, Alberta, Canada. The Initiative follows the Institute for Healthcare Improvement’s Better Health Lower Cost Road Map and pursues the Quadruple Aim. Grant funding was provided by MERCK Canada and Alberta Innovates.
Objectives The objectives of the evaluation were: 1) Determine the extent to which the Aims of the Initiative have been met; and 2) Build a measurement system to monitor the performance of the team quality improvement efforts.
Methods Over 40 providers and 445 patients participated. Data collection include: administrative data; patient surveys; and patient and staff interviews. Analyses of system level data (e.g., emergency department visits; inpatient stays; and physician continuity) included both descriptive and statistical modelling approaches from a pre/post comparison perspective.
Results Across all teams there were strong improvements in self-reported experience for both patients and providers. Some teams demonstrated reduced acute care utilisation and cost, and higher continuity with a family physician. Better outcomes were linked with teams delivering on more elements of the Managing Complex Change model: having a vision, skills, incentives, adequate resources and an action plan.
Conclusions The evaluation demonstrates that the teams have improved care for their patients. Lessons learned from this evaluation will be critical for the Initiative moving forward, and also others working with similar populations. Recommendations from the evaluation for implementing system-level improvement initiatives will be discussed, as well as recommendation for implementing measurement systems with complex patients.
Average monthly rates for emergency department visits for CTAS 4 s and 5 s. CTAS=Canadian Triage and Acuity Scale (CTAS 4 and 5 are less acute)
Average monthly emergency department visit rates (team 6)
Average monthly rate of inpatient admissions (team 1)
Average monthly usual provider continuity score (team 1)
Average monthly cost of acute care utilisation (team 1)
EQ-5D-5L Mobility dimension responses