The Quintuple Aim for Health Care Improvement: A New Imperative to Advance Health Equity
Abstract
This Viewpoint proposes expanding the quadruple aim (improving population health, enhancing the care experience, reducing costs, and addressing clinician burnout) to the quintuple aim, adding a fifth aim of advancing health equity.
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The review identified critical contextual factors influencing sustainability, including regulatory alignment, funding mechanisms, digital infrastructure, and workforce capacity.
“This approach not only captured the extent of adoption and adaptation but also identified critical contextual factors influencing sustainability, including regulatory alignment, funding mechanisms, digital infrastructure, and workforce capacity [2,3,13,17].”
From A Scoping Review of Implemented Innovations in Cancer Care: Implications for Pan-Canadian Scaling (2026) · cites this paper as [17]
Cites
The Triple Aim: Care, Health, And Cost
Berwick, D. M., Nolan, T. W., & Whittington, J. (2008) · Health Affairs · doi:10.1377/hlthaff.27.3.759 · Cited by 5,136 · see citing works
From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider
Bodenheimer, T., & Sinsky, C. (2014) · The Annals of Family Medicine · doi:10.1370/afm.1713 · Cited by 3,462 · see citing works
Communities in Action: Pathways to Health Equity
Patton-López, M. M. (2022) · Journal of Nutrition Education and Behavior · doi:10.1016/j.jneb.2021.09.012 · Cited by 759 · see citing works
Achieving Health Equity: Closing The Gaps In Health Care Disparities, Interventions, And Research
Purnell, T. S., Calhoun, E. A., Golden, S. H., Halladay, J. R., Krok-Schoen, J. L., Appelhans, B. M., & Cooper, L. A. (2016) · Health Affairs · doi:10.1377/hlthaff.2016.0158 · Cited by 329 · see citing works
Self-citationFocusing on Digital Health Equity
Lyles, C. R., Wachter, R. M., & Sarkar, U. (2021) · JAMA · doi:10.1001/jama.2021.18459 · Cited by 238 · see citing works
Mueller, M. R., Purnell, T. S., Mensah, G. A., & Cooper, L. A. (2014) · American Journal of Hypertension · doi:10.1093/ajh/hpu233 · Cited by 122 · see citing works
Self-citationPromoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment
Anderson, A. C., O’Rourke, E., Chin, M. H., et al. (2018) · Health Affairs · doi:10.1377/hlthaff.2017.1301 · Cited by 68 · see citing works
Accountable Care Organizations and Health Care Disparities
Pollack, C. E. (2011) · JAMA · doi:10.1001/jama.2011.533 · Cited by 64 · see citing works
What is the Outlook for Addressing Social Determinants of Health?
Butler, S. M. (2021) · JAMA Health Forum · doi:10.1001/jamahealthforum.2021.3639 · Cited by 17 · see citing works
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Chan, R. J., Milch, V. E., Crawford‐Williams, F., Agbejule, O. A., Joseph, R., Johal, J., Dick, N., Wallen, M. P., Ratcliffe, J., Agarwal, A., et al. (2023) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21788 · Cited by 274 · see citing works
Evidence-Informed Oral Health Policy Making: Opportunities and Challenges
Listl, S., Baltussen, R., Carrasco-Labra, A., Carrer, F. C., & Lavis, J. N. (2023) · Journal of Dental Research · doi:10.1177/00220345231187828 · Cited by 46 · see citing works
Varcoe, C., Browne, A. J., Perrin, N., Wilson, E., Bungay, V., Byres, D., Wathen, N., Stones, C., Liao, C., & Price, E. R. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08475-4 · Cited by 27 · see citing works
Sweeting, A., Hare, M. J., de Jersey, S. J., Shub, A. L., Zinga, J., Foged, C., Hall, R. M., Wong, T., & Simmons, D. (2025) · Medical Journal of Australia · doi:10.5694/mja2.52696 · Cited by 26 · see citing works
Using a health equity lens to measure patient experiences of care in diverse health care settings
Browne, A. J., Varcoe, C., Ford-Gilboe, M., Wathen, C. N., Wilson, E., Bungay, V., & Perrin, N. (2024) · PLOS ONE · doi:10.1371/journal.pone.0297721 · Cited by 17 · see citing works
Chow, E., Virani, A., Pinkney, S., Abdulhussein, F. S., van Rooij, T., Görges, M., Wasserman, W., Bone, J., Longstaff, H., & Amed, S. (2024) · Journal of Medical Internet Research · doi:10.2196/53657 · Cited by 12 · see citing works
The critical elements of digital health in diabetes and cardiometabolic care
Shomali, M., Mora, P., Aleppo, G., Peeples, M., Kumbara, A., MacLeod, J., & Iyer, A. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1469471 · Cited by 10 · see citing works
Sharma, S., Jegadeesh, G., Raynes-Greenow, C., Gordon, A., Gunawardhana, G., & Muscat, D. M. (2025) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-07091-w · Cited by 5 · see citing works
A Scoping Review of Implemented Innovations in Cancer Care: Implications for Pan-Canadian Scaling
Sampalli, T., Tomblin Murphy, G., Peacock, S., Navaratnam, S., Domm, D., & MacKenzie, K. (2026) · Current Oncology · doi:10.3390/curroncol33070395
“…by two complementary frameworks: the Quintuple Aim Framework, which informed the assessment of innovation outcomes, and the Consolidated Framework for Implementation Research (CFIR), which informed the assessment of implementation processes, contextual factors, barriers, and facilitators [13,17].”
Influential
- Authors
- Nundy, S., Cooper, L. A., & Mate, K. S.
- Affiliations
- George Washington University (US)
- Johns Hopkins University (US)
- Institute for Healthcare Improvement (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2022-02-08
- Volume
- 327
- Issue
- 6
- Pages
- 521
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W4206770545
- Cited by
- 834
- References
- 9
- Citations by year
- 2026: 177 · 2025: 248 · 2024: 217 · 2023: 150 · 2022: 40 · 2012: 1
- FWCI
- 122.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- Quintuple Aim, Quadruple Aim, health equity, population health, patient experience, health care costs, clinician burnout, healthcare quality improvement
- MeSH terms
- Health Equity, Delivery of Health Care, Humans, Quality Improvement
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