Table 3.
Examples of indicator-stem groupings and indicators within the Quintuple Aim, specific to virtual care.
| Examples of Indicator-Stem grouping (NAM Quality Domain) |
Examples of individual indicators | Examples of indicator measurement |
| Quintuple Aim domain: Patient Experience | ||
| Patient satisfaction (Patient-centredness) Usability (Efficient) |
Patient satisfaction with virtual care compared with in-person consultations | 5-point Likert scale – proportion of positive responses: “The clinical care I received during a virtual visit was the same as a face-to-face visit.” Telemedicine usability questionnaire: 18 items, 7-point Likert scale; a higher mean score indicates higher satisfaction (usefulness, ease, interface quality, interaction quality, satisfaction and future use, reliability) |
| Effectiveness | Patient-perceived value of the virtual consultation. | Net promoter score – “recommend virtual visit to a friend” Virtual visits are more convenient than an office visit |
| Access to care (Equitable) |
Ease of navigating access to a video appointment. Support to patients to overcome technical issues. |
Proportion of patients requiring help with equipment Proportion of patients having trouble logging on to platform |
| Quintuple Aim domain: Provider Experience | ||
| Provider satisfaction and preference Infrastructure/ organisational capacity (Sustainable) Provider-patient workload/workflow (Timely, efficiency) Physician perspective of effectiveness (Effective) |
Provider satisfaction compared with in-person consultations. | 5-item questionnaire using 0–100 Visual Analogue Scales – overall score calculated by averaging responses |
| Perceptions of effectiveness. | Telehealth Usability Questionnaire | |
| Provider and clinic efficiency. | Reduction in ‘no-shows’ and cancelled appointments Decrease in wait times for patients |
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| Ability to evaluate/examine patient. | Likert scales – proportion of physicians that agree: I was confident with my ability to diagnose/make recommendations. I was able to effectively inform my patient. |
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| Quintuple Aim domain: Population Health & Outcomes | ||
| Follow-up Care Access to Care Clinical outcomes and measures |
or 90-day outpatient follow-up. | Number or proportion of patients seen in follow-up after virtual visit |
| Emergency Department use after virtual visit. | Number or proportion of patients seeking emergency care after virtual visit | |
| Programme usage. | Proportion of participants engaging with the platform/completing programme | |
| Clinical effectiveness of care. | Changes in clinical outcomes/disease markers | |
| Quality of life. | Changes in QoL as measured by validated scales: EQ-5D, WHO-QL | |
| Patient safety. | Incidence of adverse clinical events | |
| Quintuple Aim domain: Cost | ||
| Health system costs Patient Costs |
Cost reduction. | Cost of standard visit compared with virtual visit |
| Cost-effectiveness. | Cost of telemedicine implementation and maintenance | |
| Cost-avoidance. | Patient travel savings compared with in-office visits | |
| Quintuple Aim domain: Equity | ||
| Accessibility Financial impact |
Equal access to care. | Availability of appropriate connectivity/ technical services in rural areas |
| Time saved by the patient | Reduction in travel time | |
EQ-5D, EuroQol-5 Dimensions – health-related quality of life scale; WHO-QL, World Health Organization-Quality of Life scale.