Evaluating the Quality of Medical Care
Item
Title
Evaluating the Quality of Medical Care
Abstract/Description
This paper is an attempt to describe and evaluate current methods for assessing the quality of medical care and to suggest some directions for further study. It is concerned with methods rather than findings, and with an evaluation of methodology in general, rather than a detailed critique of methods in specific studies.
This is not an exhaustive review of the pertinent literature. Certain key studies, of course, have been included. Other papers have been selected only as illustrative examples. Those omitted are not, for that reason, less worthy of note.
This paper deals almost exclusively with the evaluation of the medical care process at the level of physician-patient interaction. It excludes, therefore, processes primarily related to the effective delivery of medical care at the community level. Moreover, this paper is not concerned with the administrative aspects of quality control. Many of the studies reviewed here have arisen out of the urgent need to evaluate and control the quality of care in organized programs of medical care. Nevertheless, these studies will be discussed only in terms of their contribution to methods of assessment and not in terms of their broader social goals. The author has remained, by and large, in the familiar territory of care provided by physicians and has avoided incursions into other types of health care. Also, consideration of the difficult problem of economic efficiency as a measurable dimension of quality has been excluded.
Three general discussions of the evaluation of quality have been very helpful in preparing this review. The first is a classic paper by Sheps which includes an excellent discussion of methods. A more recent paper by Peterson provides a valuable appraisal of the field. The paper by Lerner and Riedel discusses one recent study of quality and raises several questions of general importance.
This is not an exhaustive review of the pertinent literature. Certain key studies, of course, have been included. Other papers have been selected only as illustrative examples. Those omitted are not, for that reason, less worthy of note.
This paper deals almost exclusively with the evaluation of the medical care process at the level of physician-patient interaction. It excludes, therefore, processes primarily related to the effective delivery of medical care at the community level. Moreover, this paper is not concerned with the administrative aspects of quality control. Many of the studies reviewed here have arisen out of the urgent need to evaluate and control the quality of care in organized programs of medical care. Nevertheless, these studies will be discussed only in terms of their contribution to methods of assessment and not in terms of their broader social goals. The author has remained, by and large, in the familiar territory of care provided by physicians and has avoided incursions into other types of health care. Also, consideration of the difficult problem of economic efficiency as a measurable dimension of quality has been excluded.
Three general discussions of the evaluation of quality have been very helpful in preparing this review. The first is a classic paper by Sheps which includes an excellent discussion of methods. A more recent paper by Peterson provides a valuable appraisal of the field. The paper by Lerner and Riedel discusses one recent study of quality and raises several questions of general importance.
Author/creator
Date
In publication
Volume
83
Issue
4
Pages
691-729
Resource type
Background/Context
Medium
Print
Background/context type
Other
Open access/free-text available
Yes
Peer reviewed
Yes
ISSN
1468-0009
Citation
Donabedian, A. (2005). Evaluating the Quality of Medical Care. The Milbank Quarterly, 83(4), 691–729. https://doi.org/10.1111/j.1468-0009.2005.00397.x
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