Using the Quadruple Aim Framework to Measure Impact of Heath Technology Implementation: A Case Study of eConsult
Open accessAbstract
BACKGROUND: Health technology solutions are too often implemented without a true understanding of the system-level problem they seek to address, resulting in excessive costs, poor adoption, ineffectiveness, and ultimately failure. Before implementing or adopting health care innovations, stakeholders should complete a thorough assessment to ensure effectiveness and value. In this article, we describe how to evaluate the impact of a health technology innovation through the 4 dimensions of care outlined by the Quadruple Aim Framework, using our experience with the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service as a case example. METHODS: A descriptive overview of data was collected between April 1, 2011, and August 31, 2017, using 4 dimensions of care outlined by the Quadruple Aim Framework: patient experience, provider experience, costs, and population health. Findings were drawn from use data, primary care provider closeout surveys, surveys/interviews with patients and provider, and costing data. RESULTS: Overall, patients have received access to specialist advice within days and find the advice useful in 86% of cases. Provider experience is very positive, with satisfaction ratings of high/very high value in 94% of cases. The service cost a weighted average of $47.35/case, compared with $133.60/case for traditional referrals. In total, 1,299 primary care providers have enrolled in the service, completing 28,838 cases since 2011. Monthly case volumes have grown from an average of 13 cases/month in 2011 to 969 cases/month in 2016. CONCLUSIONS: The eConsult service has been widely adopted in our region and is currently expanding to new jurisdictions across Canada. However, although we successfully demonstrated eConsult's impact on patient experience, provider satisfaction, and reducing costs, we met several challenges in evaluating its impact on population health. More work is needed to evaluate eConsult's impact on key population health metrics (eg, mortality, morbidity, and system use). Efforts to conduct such evaluations are underway.
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The Champlain BASE eConsult service has grown from a small proof-of-concept to a fully implemented regional service, with a solid body of evidence supporting its ability to improve access to specialist advice, reduce wait times, lower costs, and deliver high levels of patient and provider satisfaction.
“First launched in 2009, this innovative service has grown from a small proof-of-concept to a fully implemented regional service, with a solid body of evidence supporting its ability to improve access to specialist advice, reduce wait times, lower costs, and deliver high levels of patient and provider satisfaction [8–10].”
From Key factors for national spread and scale-up of an eConsult innovation (2020) · cites this paper as [8]
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- Authors
- Liddy, C., & Keely, E.
- Affiliations
- University of Ottawa (CA)
- ORCID
- Liddy, Clare
- Venue
- The Journal of the American Board of Family Medicine
- Published
- 2018-05
- Volume
- 31
- Issue
- 3
- Pages
- 445-455
- ISSN
- 1557-2625 (ISSN-L)
- 1558-7118
- OpenAlex
- W2800380926
- Cited by
- 42
- References
- 38
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 7 · 2022: 10 · 2021: 4 · 2020: 5 · 2019: 9 · 2018: 2
- FWCI
- 8.27
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of the American Board of Family Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ontario Ministry of Health and Long-Term Care
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Keywords
- e-consultation, health technology implementation, specialist referral, access to specialist care, patient experience, provider satisfaction, health care costs, population health, primary care
- MeSH terms
- Implementation Science, Canada, Health Services Accessibility, Humans, Primary Health Care, Remote Consultation
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