Adopting the Triple Aim Framework in the Saudi Healthcare System: A Delphi Study

Figures & data

Table 1 Experts Characteristics Round

		Count	Table N %
Gender	Female	6	35.3%
	Male	11	64.7%
Years of experience	More than 10 years	17	100.0%
Sector	Academic	3	17.6%
	Government	10	58.8%
	Government, Academic	1	5.9%
	Government, Private	1	5.9%
	Private	2	11.8%
Educational qualification	Bachelor’s	1	5.9%
	Master’s	10	58.8%
	PhD	6	35.3%

Table 2 Round One Measures Which Did Not Reach Experts Consensus

Indicator	Disagree = 1		Neutral = 2		Agree = 3		Mean	STD
	C	%	C	%	C	%
Life expectancy (LE)	0	0.0%	1	5.9%	16	94.1%	2.94	0.250
Years of potential life lost (YPLL)	0	0.0%	4	23.5%	13	76.5%	2.75	0.447
Standardized mortality ratio (SMR):	4	23.5%	2	11.8%	11	64.7%	2.50	0.816
Single-question health status	4	23.5%	3	17.6%	10	58.8%	2.31	0.873
Multi-domain health/functional status:	2	11.8%	5	29.4%	10	58.8%	2.50	0.730
Utility-based health/functional status:	0	0.0%	5	29.4%	12	70.6%	2.75	0.447
Incidence: Annual rate or average age at onset for identified conditions	0	0.0%	4	23.5%	13	76.5%	2.81	0.403
Prevalence: Percent of a population with identified conditions	1	5.9%	1	5.9%	15	88.2%	2.81	0.544
Predictive model scores	2	11.8%	5	29.4%	10	58.8%	2.50	0.730
Behavioral and physiological factors	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
US CAHPS survey (HHS/AHRQ)	2	11.8%	3	17.6%	12	70.6%	2.63	0.719
How’s your health global question:	1	5.9%	7	41.2%	9	52.9%	2.50	0.632
NHS World Class Commissioning (WCC) or Care Quality Commission experience questions	0	0.0%	7	41.2%	10	58.8%	2.63	0.500
Key global questions from a current patient survey (eg, likelihood to recommend)	2	11.8%	9	52.9%	6	35.3%	2.25	0.683
IOM dashboard created impact the health care experience of an individual: safe, effective, timely, efficient, equitable, patient-centered.	0	0.0%	1	5.9%	16	94.1%	2.94	0.250
Total cost per member (or citizen) of the population per month:	6	35.3%	0	0.0%	11	64.7%	2.38	0.957
Hospital and Emergency Department (ED) utilization rate	3	17.6%	2	11.8%	12	70.6%	2.50	0.816

Note: Underlined and bold percentages indicate measures that experts did not reach consensus upon.

Table 3 Round Two Measures Which Did Not Reach Experts Consensus

Indicator	Disagree		Neutral		Agree		Mean	STD
	C	%	C	%	C	%
Years of potential life lost (YPLL)	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
Standardized mortality ratio (SMR):	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Single-question health status	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Multi-domain health/functional status:	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Utility-based health/functional status:	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Incidence: Annual rate or average age at onset for identified conditions	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Predictive model scores	0	0.0%	6	35.3%	11	64.7%	2.65	0.493
US CAHPS survey (HHS/AHRQ)	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
How’s Your Health Global question:	0	0.0%	3	17.6%	14	82.4%	2.82	0.393
NHS World Class Commissioning (WCC) or Care Quality Commission experience questions	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
Key global questions from a current patient survey (eg, likelihood to recommend)	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Total cost per member (or citizen) of the population per month	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Hospital and Emergency Department (ED) utilization rate	0	0.0%	3	17.6%	14	82.4%	2.82	0.393

Note: Underlined and bold percentages indicate measures that experts did not reach consensus upon.

Table 4 The Final Set of Measures Reached Consensus by the Experts

Indicator	Disagree = 1		Neutral = 2		Agree = 3		Mean	STD
	C	%	C	%	C	%
Life expectancy (LE)	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Years of potential life lost (YPLL)	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
Standardized mortality ratio (SMR):	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Single-question health status	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Multi-domain health/functional status:	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Utility-based health/functional status:	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Incidence: Annual rate or average age at onset for identified conditions	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Prevalence: Percent of a population with identified conditions	1	5.9%	1	5.9%	15	88.2%	2.82	0.529
Behavioral and physiological factors	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
US CAHPS survey (HHS/AHRQ)	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
How’s Your Health Global question:	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
NHS World Class Commissioning (WCC) or Care Quality Commission experience questions	0	0.0%	3	17.6%	14	82.4%	2.82	0.393
Key global questions from a current patient survey (eg, likelihood to recommend)	0	0.0%	0	0.0%	17	100.0%	3.00	0.000
IOM dashboard created impact the health care experience of an individual: safe, effective, timely, efficient, equitable, patient-centered.	0	0.0%	2	11.8%	15	88.2%	2.88	0.332
Total cost per member (or citizen) of the population per month:	0	0.0%	1	5.9%	16	94.1%	2.94	0.243
Hospital and Emergency Department (ED) utilization rate	0	0.0%	2	11.8%	15	88.2%	2.88	0.332

Table 5 Adopted Framework’s Measures

Triple Aim Domain	Subdomain and Outcome Measure
Population health	Health outcomes Mortality: years of life lost, life expectancy, standardized mortality ratio, Health and functional status: single question about general health, multidomain assessment Healthy life expectancy Disease Burden Incidence and prevalence of major conditions Behavior and physiological Factors Behavioral factor (physical activity, and diet) Physiological factor (blood glucose)
Experience of care	Standard question from patient surveys Consumer Assessment of Healthcare Providers and Systems (CAHPS) Likelihood to recommend Institute of Medicine Key Dimensions Safe, effective, timely, efficient, equitable, and patient-centered.
Per capita cost	Total cost per member of the population Hospital and Emergency department utilization rate and cost