Despite these endorsements, progress in mitigating health care inequities has been painfully slow. Health equity has subsequently been endorsed by CMS, the Joint Commission, the National Committee for Quality Assurance, the National Quality Forum, and other important stakeholders. Health equity has been recognized as a core dimension of quality for more than two decades, beginning with the Institute of Medicine Report (Crossing the Quality Chasm, 2001). However, adding health equity as a quintuple aim is too much in terms of aims and too little in terms of priority. The preceding paper by Dzau et al offers further support for health equity being a national priority. The authors articulate cogent arguments for health equity improvement being a national aim. Adding health equity as the quintuple aim, with its linkage to measurement, transparency, and reimbursement, will help sustain attention to persistent inequities plaguing our health systems and communities. We are coupling that approach with the training and engagement of trusted community voices such as Black church leaders, hair-dressers and barbers, and community-based pharmacists. At the Center for Sustainable Health Care Quality and Equity (SHC) we are implementing quality improvement education programs for clinical teams serving people of color, helping them close gaps in vaccination, diabetes management, evidence-based heart failure treatment, and other conditions characterized by disparities in care and outcomes. Strategies that helped make vaccines more available, such as true community engagement, delivery of services in the community, and attention to social determinants of health, will not continue. But my colleagues and I fear that the urgency to address equity will fade as the pandemic recedes. COVID certainly spotlighted health inequities. Interpersonal interventions patient–provider communication quadruple aim systematic review.I applaud the authors' call for making health equity the fifth rail of the "quintuple" aim, including measurable and transparent reporting, consideration of systemic contributing factors, and tying it to reimbursement. Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. Among studies that measured time in the clinical encounter, intervention effects varied. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Most studies measured impact on patient experience improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). The methodological quality of research was moderate to high for most included studies 67% of interventions targeted the provider. Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. provider-patient dyad), and quadruple aim outcomes. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. Two abstractors independently extracted information about study design, methods, and quality. Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions.
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