PubMed Health⌕ Search

Biomedical subjects

A Donabedian

Publications and source records attributed to A Donabedian.

At least 19 recordsLinked to original sources
PubMed1991

Health science information management. An approach to improving QA and clinical practice.

To help quality assurance (QA) professionals and clinical practitioners keep up with advances in health care knowledge and technology, we describe a prototype Health Science Information Management (HSIM) publication. We conceptualize HSIM to include: (a) identification of unique science information needs; (b) rapid retrieval of valid needed information; and (c) use the information to improve health care benefits. To more adequately accomplish these functions, we suggest that five specific categories of information will be essential: (1) reports of recent advances in Science Information Management methods; (2) original reports of Science Information Syntheses (SISs) providing information immediately applicable for QA; (3) previously published reports of "classic" SISs relevant to QA; (4) reviews of new technologies and products immediately applicable to quality management; (5) cumulative indexing of the above methods and products. Making the above information available to QA professionals might substantially improve the impact of quality management.

Abstracting and Indexing↗
PubMed1990

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 payers impose a different standard of optimal care, I suggest that health care professionals will respond in one of three ways: oppose intervention, adopt the economic optimum, or take an intermediate position by accepting the payer's 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 of its view of the public good.

Cost-Benefit Analysis↗
PubMed1990

The seven pillars of quality.

Seven attributes of health care define its quality: (1) efficacy: the ability of care, at its best, to improve health; (2) effectiveness: the degree to which attainable health improvements are realized; (3) efficiency: the ability to obtain the greatest health improvement at the lowest cost; (4) optimality: the most advantageous balancing of costs and benefits; (5) acceptability: conformity to patient preferences regarding accessibility, the patient-practitioner relation, the amenities, the effects of care, and the cost of care; (6) legitimacy: conformity to social preferences concerning all of the above; and (7) equity: fairness in the distribution of care and its effects on health. Consequently, health care professionals must take into account patient preferences as well as social preferences in assessing and assuring quality. When the two sets of preference disagree the physician faces the challenge of reconciling them.

Costs and Cost Analysis↗
PubMed1989

Institutional and professional responsibilities in quality assurance.

The quality of care has three components: the goodness of technical care, judged by its effectiveness, the goodness of the interpersonal relationship, judged partly by its contribution to technical care, and the goodness of the amenities. Quality assurance protects and enhances quality through system design and performance monitoring. Monitoring may occur informally in the course of collaborative practice. Formal monitoring is conducted by: (1) systematically collecting information about the process and outcome of care, (2) identifying patterns of practice, (3) explaining these patterns, (4) acting to correct deficiencies, and (5) verifying the effects of remedial actions. Rather than being a policing activity, monitoring implements professional accountability and contributes to rational management by documenting the quality of the product. Its effectiveness depends in specified ways on (1) leadership, (2) organizational characteristics, (3) characteristics of health care professionals, (4) features of the method of monitoring, and (5) methods used to influence practitioner behavior.

Clinical Competence↗
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

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↗