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 indicatorsExamples of indicator measurement
Quintuple Aim domain: Patient Experience
Patient satisfaction
(Patient-centredness)
Usability
(Efficient)
Patient satisfaction with virtual care compared with in-person consultations5-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)
EffectivenessPatient-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
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.
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 patientReduction in travel time
  • EQ-5D, EuroQol-5 Dimensions – health-related quality of life scale; WHO-QL, World Health Organization-Quality of Life scale.