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Quality Health Outcomes Model
Author(s) -
Mitchell Pamela H.,
Ferketich Sandra,
Jennings Bonnie M.
Publication year - 1998
Publication title -
image: the journal of nursing scholarship
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.009
H-Index - 80
eISSN - 1547-5069
pISSN - 0743-5150
DOI - 10.1111/j.1547-5069.1998.tb01234.x
Subject(s) - scope (computer science) , psychological intervention , quality (philosophy) , affect (linguistics) , outcome (game theory) , perspective (graphical) , quality management , health care , management science , process management , intervention (counseling) , process (computing) , psychology , medicine , business , computer science , nursing , operations management , economics , management system , economic growth , philosophy , communication , epistemology , mathematical economics , artificial intelligence , operating system , programming language
Purpose: Donabedian's 1966 framework of structure, process, and outcome has guided three decades of study in the United States of the elements needed to evaluate and compare medical care quality. Donabedian's perspective was essentially linear, assuming that structures affect processes, which in turn affect outcomes. Patient characteristics are sometimes considered as mediating outcomes and clinical interventions are considered to be processes. A model is presented in the following article that relates multiple factors affecting quality of care to desired outcomes. It extends previous models by positing dynamic relationships with indicators that not only act upon, but reciprocally affect the various components. Scope and Sources: The proposed model was derived from a synthesis of the authors' experience in quality of care practice and research, as well as selected previous theories. Conclusions: The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.