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Biomedical subjects

A Donabedian

Publications and source records attributed to A Donabedian.

At least 37 records · Page 2Linked to original sources
PubMed1989

The end results of health care: Ernest Codman's contribution to quality assessment and beyond.

E.A. Codman's conception and development of the "end result idea" in the 1910s are unduly neglected in the history of health care assessment. The "idea" entailed following patients long enough to determine if treatments proved successful and taking comprehensive measures to prevent new failures if outcomes were undesirable. Codman's work anticipated contemporary approaches to quality monitoring and assurance, establishing accountability, and allocating and managing resources efficiently, among other assessment features. Complexity and ambiguity in health care objectives, decision making, and role responsibilities as well as costs today hinder full application of his vision, but refinement of these factors proceeds in the directions Codman set forth.

History, 19th Century↗
PubMed1988

The assessment of technology and quality. A comparative study of certainties and ambiguities.

Though technology assessment and quality assessment have much in common, they differ significantly in emphasis. Technology assessment judges technology itself; quality assessment examines the extent to which a technology is used well in its various settings. This article explores the nature of quality assessment--including the performance of individual practitioners as they care for individual patients and the care received by communities--and examines its interrelationship with technology assessment.

Health Services Research↗
PubMed1988

Monitoring: the eyes and ears of healthcare.

Society and the healthcare profession are bound by a contract, sealed with the healthcare practitioner's obligation to competence, integrity, and humaneness. Society confers privileges on the practitioner, who, in turn, accepts the obligations that society also imposes. Nevertheless, repeated assessments under all sorts of conditions have revealed unexpected, often serious defects in the quality of healthcare. The quality of healthcare depends on the performance of practitioners in a healthcare system--how much and how they improve health. The means used should be socially legitimate, acceptable to patients, and economically efficient. Some key elements and considerations in the performance of a healthcare system include patient care, population care, patient access to the system, outcomes, patient satisfaction, and the nature of the patient-practitioner encounter. Not knowing how to assess technical care, patients judge quality mainly by the attributes of the interpersonal relationship with practitioners--personal interest, empathy, responsiveness, and trust--and by whether the outcomes of care meet their expectations. Some requirements for maintaining and enhancing quality include values, human and material resources, knowledge, system design, and performance monitoring. Without a commitment to quality, healthcare practitioners betray not only those who trust them, but also themselves.

Hospital Administration↗
PubMed1988

Quality assessment and assurance: unity of purpose, diversity of means.

In this paper I attempt to advance our understanding and appreciation of the several contributions to this anthology by placing their more important features in a unifying framework. In this way I hope to show their historical antecedents, their interrelationships, and their linkages to the central problems and purposes of quality assessment and assurance. But above all, I celebrate our rededication to quality in health care.

Consumer Behavior↗
PubMed1988

Quality and cost: choices and responsibilities.

Practitioners are at least obligated to provide the most effective care most efficiently. But when added benefits are small relative to added cost, practitioners may stop short of the most effective care in obedience to patient preferences. If society imposes a different standard of optimal care, I suggest that health care professionals will respond in one of three ways: oppose social intervention, adopt the social optimum, or take an intermediate position by accepting the social specification of optimal care but safeguarding the individual practitioner's role as an advocate for each patient and the profession's role as an advocate its view of the public good.

Cost-Benefit Analysis↗
PubMed1987

Assessing the quality of care in a hospital emergency unit: a framework and its application.

This article presents a specific application of a general approach to quality assessment by describing in detail both the theoretical and the practical aspects of quality assessment in a hospital emergency unit. The theoretical framework is established by specifying the level and scope of assessment, adopting a definition of quality, modeling emergency care as a succession of phases, specifying evaluative attributes, choosing a method for case selection, and selecting one or more methods of assessment. The practical application of this framework is illustrated using two methods, "tracer" and "trajectory," and selecting specific conditions amenable to assessment with each method.

Emergency Service, Hospital↗
PubMed1987

State intervention in medical care: types, trends and variables.

This article attempts to develop some of the basic elements for a theory of state intervention in medical care. First, a typology of state intervention is proposed based on two dimensions: the form of state control over the production of medical services and the basis for eligibility of the population. The resulting twelve types provide a means of describing national patterns of state intervention at a given point in time. Next, in order to analyse the changing patterns of state intervention in medical care over time, changes in state control and population coverage are used to construct three hypothetical 'paths' of state intervention, which may serve to depict broad historical trends in major groups of countries. In the final section, several variables are analysed according to their expected effect on the patterns of convergence and divergence in the form and degree of state intervention between countries. This cross-national comparative perspective is offered as a strategy for building a theory capable of explaining state intervention, a process that, to a large extent, informs the medical experience of today.

Eligibility Determination↗
PubMed1987

Commentary on some studies on the quality of care.

This essay is a personal commentary on general aspects of quality assessment that are either illustrated or challenged by the articles presented in this volume. It is not a critique of the individual papers in the collection; papers are mentioned in order to illustrate or clarify a point, without implication of either merit or demerit. This article addresses the definitions of quality, the relationship of cost to quality, approaches to assessing quality, the use of case fatality as an indicator of quality, measures of post-hospital morbidity, case-mix adjustment, sources of information, selection of referents, criteria and standards, quality assurance, the role of consumers, the prevalence of quality, the effects of prospective payment, and a research agenda.

Evaluation Studies as Topic↗
PubMed1985

Twenty years of research on the quality of medical care: 1964-1984.

Since 1964 we have built on earlier work, with some refinements, particularly in the formulation of explicit criteria of process and outcome; the detailed standardization of case mix when outcomes signify quality; the prespecification of outcomes for follow-up, when adverse outcomes are only the occasion for later assessment of process; a greater emphasis on more subtle organizational characteristics in the study of structure; and the identification of the separate effects of structural attributes by multivariate analysis. We have also paid more systematic attention to questions of measurement, including the veracity and completeness of the record; the procedures of criteria formulation; and the reliability, validity, and screening efficiency of the criteria. A notable advance is the use of decision analysis to identify optimal strategies of care, including the introduction of patient preferences and monetary cost in the specification of such strategies, and the use of decisional algorithms to portray the criteria of quality.

Evaluation Studies as Topic↗
PubMed1985

The epidemiology of quality.

The quality of care can be perceived to have an "epidemiology" in that it is distributed in each of two populations, one of providers and another of clients. In this review of the pertinent literature, I found, overall, that the quality of technical care is better when practitioners have better or more training, are more specialized, and are more experienced though not too old; when they provide ambulatory care by appointment to a not overly large caseload in well-equipped premises and possibly in association with colleagues; and when they provide hospital care in larger institutions with significant teaching functions. I found no consistent correlation between quality and age, sex, rurality, occupation, income, and ethnicity of patients, but there were enough intimations of a relation between socioeconomic disadvantage and poorer technical care to prompt careful study.

Accreditation↗