![]() In the 20 years since the publication of the Chiles et al. The analysis of this data also revealed that planned, evidence-supported psychoeducational interventions yielded greater positive outcomes than open-ended, nonspecific interventions, but all yielded positive results. The reduced costs were the result of the decreasing length of inpatient stays for medical and surgical patients and fewer emergency department visits. This analysis of 91 research studies, conducted between 19 across a range of clinical problems in all age groups, for both inpatients and outpatients, and in both surgical and medical settings, found a decreased use of health services after psychological interventions in 90 percent of the studies, with an average 15.7 percent reduction in costs, whereas costs increased an average of 12.2 percent in control groups. The positive impact of psychological interventions on health outcomes and the subsequent reduction in the need for health services was summarized in classic meta-analysis by Chiles, Lambert, and Hatch (1999). If the health care system is to truly achieve the quadruple aim, it must systematically address behavior change. Thus, both health behaviors and mental health disorders contribute significantly to overall costs and outcomes. In addition, the presence of such high-frequency disorders as anxiety and depression result in much higher health care costs for commonly occurring diagnoses such as diabetes or heart disease (Melek, Norris, & Paulus, 2014). We know from existing public health research that 45 percent or more of all health outcomes are due to such behaviors as sedentary behavior, poor diet, smoking, substance misuse, stress, and nonadherence to prescribed treatments (World Health Organization, 2009). These disparate studies have been compiled in a volume (see Hunter, Hunter, & Kessler, 2014) that encompasses psychological interventions in primary and specialty medical and surgical care, as well as both outpatient and inpatient care. They have also addressed the needs of entire patient panels and developed systems to improve providers’ satisfaction with their work. Psychologists have long been participating on teams that have produced positive outcomes in terms of clinical improvement and reduced costs resulting from the improved health of patients. Individual researchers and groups have addressed each of the components of these goals in a range of studies over the years. Psychology is uniquely positioned within the health professions to help the system achieve the goals of the quadruple aim. As work has proceeded on this “triple aim,” the additional goal of provider satisfaction - improving the work life of health care providers - has resulted in the quadruple aim (Bodenheimer & Sinsky, 2014). Reorienting the health care system to achieve three interdependent goals - improved patient experience, leading to better health, resulting in lower costs, all carried out within a population-based framework focused on the health of a community - has been the subject of much research (e.g., Berwick, Nolan, & Whittington, 2008).
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