Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T01:31:38.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Contributions of Epidemiology to Quality Assessment and Monitoring

Published online by Cambridge University Press:  21 June 2016

Avedis Donabedian
Avedis Donabedian*
Affiliation:
School of Public Health, University of Michigan, Ann Arbor, Michigan
*
School of Public Health, University of Michigan, Ann Arbor, MI 48109-0099
Get access Rights & Permissions [Opens in a new window]

Extract

The contribution of epidemiology to quality assessment and monitoring: a clear enough subject. But as I approached it, it slipped into ambiguity and confusion. What was quality assessment? What was monitoring? For that matter, what was quality? And the meaning of epidemiology was the deepest mystery of all.

I must begin by defining my terms. Quality shall be taken to mean making a judgment on the goodness of healthcare, based on one or more of the following: the expected or realized ability of the care to achieve the greatest improvement in health that the current science and technology of healthcare can achieve; acceptability to patients (including their families); and acceptability to the community (or the society at large). There are three ways in which we can find out if healthcare has been good in these respects. First is the examination of the process of care, which I take to mean the degree to which what is done for and by patients corresponds to what is known or believed to be most effective in improving health, and most acceptable to patients and to society. Second is the examination of the outcomes of care, meaning the degree to which the care provided is acceptable and has attained achievable improvements in health. Third is the examination of structural attributes, meaning the degree to which the physical and organizational settings in which care is given are conducive to the kind of care that can be expected to improve health and to be acceptable to patients and to the community. So much for quality assessment.

Type
Special Sections
Information
Infection Control & Hospital Epidemiology , Volume 11 , Issue 3 , March 1990 , pp. 117 - 125
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1990

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Williamson, JW. Evaluating quality of patient care: a strategy relating outcome and process assessment. JAMA. 1971;218:564–569.CrossRefGoogle ScholarPubMed
2. Greenfield, S, Lewis, CE, Kaplan, SH, Davidson, MB. Peer review by criteria mapping: criteria for diabetes mellitus: the use of decision-making in chart audit. Ann Intern Med. 1975;83:761–770.CrossRefGoogle ScholarPubMed
3. Donabedian, A. Using decision analysis to formulate process criteria for quality assessment, Inquiry. 1981;18:102–119.Google ScholarPubMed
4. Donabedian, A, Wheeler, JRC, Wyszewianski, L. Quality, cost, and health: an integrative model. Med Care. 1982;20:975–992.CrossRefGoogle ScholarPubMed
5. Hodgson, TA, Meiners, MR. Cost-of-illness methodology: a guide to current practice and procedures. Milbank Memorial find Quarterly: Health and Society. 1982;60:429–462.CrossRefGoogle Scholar
6. Torrance, GW. Measurement of health status utilities for economic appraisal: a review. Journal of Health Economics. 1986;5:1–30.CrossRefGoogle Scholar
7. Hulka, BS, Kupper, LL, Daly, MB, Cassel, JC, Sheen, F. Correlates of satisfaction and dissatisfaction with medical care. Med Care. 1975;13:648–658.CrossRefGoogle ScholarPubMed
8. McNeil, BJ, Weichselbaum, R, Pauker, SG. Fallacy of the five-year survival in lung cancer. N Eng J Med. 1978;299:1397–1401.CrossRefGoogle ScholarPubMed
9. McNeil, BJ, Weichselbaum, R, Pauker, SG. Speech and survival: trade-offs between quality and quantity of life in laryngeal cancer. N Eng J Med. 1981;305:982–987.CrossRefGoogle Scholar
10. Howie, JGR. Death from appendicitis and appendectomy: an epidemiological survey. Lancet. 1966;2:1334–1337.CrossRefGoogle Scholar
11. Howie, JGR. The place of appendectomy in the treatment of young adult patients with possible appendicitis. Lancet. 1968;1:1365–1367.CrossRefGoogle ScholarPubMed
12. Neutra, R. Indications for the surgical treatment of suspected acute appendicitis: a cost-effectiveness approach. In: Bunker, JP, Barnes, BH, Mosteller, F, eds. Costs, Risks, and Benefits of Surgery. New York: Oxford University Press; 1977:277–307.Google Scholar
13. Palmer, RH, Reilly, MC. Individual and institutional variables which may serve as indicators of quality of medical care. Med Care. 1979;17:693–717.CrossRefGoogle ScholarPubMed
14. Donabedian, A. The epidemiology of quality. Inquiry. 1985;22:282–292.Google ScholarPubMed
15. Donabedian, A. Explorations in Quality Assessment and Monitoring, Volume III, The Methods and Findings of Quality Assessment and Monitoring: An Illustrated Analysis. Ann Arbor, Mi: Health Administration Press; 1985.Google Scholar
16. Wennberg, J, Gittelsohn, A. Small area variation in health care delivery. Science. 1973;182:1102–1108.CrossRefGoogle Scholar
17. Wennberg, JE. Dealing with medical practice variations: a proposal for action. Health Aff. 1984;3:6–32.CrossRefGoogle Scholar
18. Paul-Shaheen, P, Clark, J, Williams, D. Small area analysis: a review of the North American literature. J Health Polit Policy Law. 1987;12:741–809.CrossRefGoogle ScholarPubMed
19. Chassin, MR, Kosecoff, J, Park, RE, et al. Does inappropriate use explain geographic variations in the use of health care services? A study of three procedures. JAMA. 1987;258:2533–2537.CrossRefGoogle ScholarPubMed
20. Gordis, L. Effectiveness of comprehensive-care programs in preventing rheumatic fever. N Eng J Med. 1973;289:331–335.CrossRefGoogle ScholarPubMed
21. Scott, WR, Forrest, WH Jr Brown, BW Jr. Hospital structure and postoperative mortality and morbidity. In: Shortell, SM, Brown, J, eds. Organizational Research in Hospitals. Chicago, Il: Blue Cross Association; l976:72–82.Google Scholar
22. Scott, WR, Flood, AB, Ewy, W. Organizational determinants of services, quality and cost of care in hospitals. Milbank Memorial Fund Quarterly: Health and Society. 1979;57:234–264.CrossRefGoogle ScholarPubMed
23. Becker, MH, Drachman, RH, Kirscht, JP. A field experiment to evaluate various outcomes of continuing physician care. Am J Public Health. 1974;64:1062–1070.CrossRefGoogle Scholar
24. Brook, RH, Davies-Avery, A, Greenfield, S, et al. Assessing the quality of medical care using outcome measures: an overview of the method. Med Care. 1977;15S.Google Scholar
25. Hulka, BS, Romm, FJ, Parkerson, GR Jr Russell, IT, Clapp, NE, Johnson, FS. Peer review in ambulatory care: use of explicit criteria and implicit judgments. Med Care. 1979;15S.Google Scholar
26. Wagner, EH, William, CA, Greenberg, R, Kleinbaum, D, Wolf, S, Ibrahim, MA. A method for selecting criteria to evaluate medical care. Am J Public Health. 1978;68:464–470.CrossRefGoogle ScholarPubMed
27. Osborne, CE, Thompson, HC. Criteria for evaluation of ambulatory child health care by chart audit: development and testing of a methodology. Pediatrics. 1975;56S.Google Scholar
28. Hulka, BS, Zyzanski, SJ, Cassel, JC, Thompson, ST Scale for the measurement of attitudes toward physicians and primary medical care. Med Care. 1970;8:429–436.CrossRefGoogle ScholarPubMed
29. Brook, RH, Ware, JE Jr Davies-Avery, A, et al. Overview of adult health status measures fielded in Rand's health insurance study. Med Care. 1979;7S.Google Scholar
30. Stewart, AL, Ware, JE Jr Brook, RH. Advances in the measurement of functional status: construction of aggregate indexes. Med Care 1981;19:473–488.CrossRefGoogle ScholarPubMed
31. Katz, S, Akpom, A. A measure of primary sociobiological functions. Int J Health Serv. 1976;6:493–507.CrossRefGoogle ScholarPubMed
32. Breslow, L. A quantitative approach to the world health organization definition of health: physical, mental and social well-being. Int J Epidemiol. 1972;1:347–355.CrossRefGoogle Scholar
33. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985;121:182–205.CrossRefGoogle ScholarPubMed
34. Donabedian, A. Specialization in clinical performance monitoring: what it is and how to achieve it. Quality Assurance and Utilization Review . In press.Google Scholar