The Quality of Care
How Can It Be Assessed?
- Avedis Donabedian, MD, MPH
Abstract
Before assessment can begin we must decide how quality is to be defined and that depends on whether one assesses only the performance of practitioners or also the contributions of patients and of the health care system; on how broadly health and responsibility for health are defined; on whether the maximally effective or optimally effective care is sought; and on whether individual or social preferences define the optimum. We also need detailed information about the causal linkages among the structural attributes of the settings in which care occurs, the processes of care, and the outcomes of care. Specifying the components or outcomes of care to be sampled, formulating the appropriate criteria and standards, and obtaining the necessary information are the steps that follow. Though we know much about assessing quality, much remains to be known.
(JAMA 1988;260:1743-1748)
Footnotes
-
This article was written for the AMA Lectures in Medical Science: it is the basis for a lecture in that series given on Jan 11, 1988, by invitation of the Division of Basic Sciences, American Medical Association, Chicago.
-
Reprint requests to 1739 Ivywood Dr, Ann Arbor, MI 48103.
