Table 3.

Impact domains and alignment of studies to quadruple health care aim (Bodenheimer and Sinsky, 2014)¹¹.

Key impact domains	Measures and/or indicators	Mapping to the quadruple aims of health care delivery
Patient outcomes and experience	Neonatal deaths; prematurity deaths; Counts of patient safety events; Adverse drug events for: elderly, more common, less complex patients; Count or rate of medication errors; near-missed events avoided; Iatrogenic injury avoidance. Patient pain score, patient anxiety score; patient confidence in healthcare system rating; Quality adjusted life years;	- Improve population health - Enhance patient experience
Hospital outcomes	Change in mortality rate; Mortality rate after adverse drug event; 30-day mortality rate; Rate of readmission; reduced readmission rates; changes of infection rate; Length of stay for repeat patients; Length of stay (rate of change for); Length of stay for less complex patients. Quality of care provided; Acute myocardial quality scores; Pneumonia quality score; Congestive heart failure quality score; Composite quality score.	- Improve population health - Enhance patient experience - Reduce cost per patient
Health system outcomes	Crude mortality per 1000 population for: hypertension related mortality; maternal related mortality; infant related mortality; child 1-5 mortality; child 1-5 HIV deaths attributable to mother to child transmission of HIV; adverse drug related mortality; acute respiratory infection related mortality in over five years.	- Improve population health
Cost specific for EMR implementation	Initial capital costs for: Development; Implementation; Training; Hardware; Marketing; Electronics; Office supplies. Ongoing costs for: Paper scanning system; New medical record creation; information technology support; Medical transcriptionists; Maintenance; Software; Meeting times;	- Reduce cost per patient
Hospital resource utilization	Laboratory tests per week; Radiology examinations; Iatrogenic testing; Head CT scans; Chest radiographs; Body CT scans; Consultations; Prescriptions; Paper storage space reutilization; Litigation cost; Medicare spending; Labor costs; Redundant employees; Nursing and pharmacy salary costs; Nursing scheduling; Physician workload; Administration time	- Reduce cost per patient
Productivity and efficiency measures	Inefficiency scores; productivity change over time; Rate of change in cost per patient; Per patient costs; Outpatient average spending;	- Reduce cost per patient