Some quotes from Donabedian

So who is Donabedian? He wrote the classic paper “Evaluating the Quality of Medicare Care” in 1966. Most researchers and experts revere the Donabedian formulation. I would argue though that many advocates of P4P need to read Donabedian. I will give a few quotes from his paper as food for thought:

Which of a multitude of possible dimensions and criteria are selected to define quality will, of course, have profound influence on the approaches and methods one employs in the assessment of medical care.

Many factors other than medical care may influence outcome, and precautions must be taken to hold all significant factors other than medical care constant if valid conclusions are to be drawn.

Judgments of quality are incomplete when only a few dimensions are used and decisions about each dimension are made on the basis of partial evidence.

A major problem, yet unsolved, in the construction of numerical scores, is the manner in which the different components are to be weighted in the process of arriving at the total.

In addition to defects in method, most studies of quality suffer from having adopted too narrow a definition of quality. In general, they concern themselves with the technical management of illness and continuity of care, or handling the patient-physician relationship. Presumably, the reason for this is that the technical requirements of management are more widely recognized and better standardized. Therefore, more complete conceptual and empirical exploration of the definition of quality is needed.

Amen.