Structure, Process, Outcomes PDF Print E-mail

Donabedian (2005) suggests that evaluation of care can be conceptualized into three dimensions:  structure, processes and outcomes

  • Structure refers to the setting in which care is delivered including adequate facilities and equipment, qualification of care providers, administration structure and operations of programs.  Using this approach, good care settings and supporting structures contribute to good care.  Structure variables are often concrete and accessible, making them relatively easy to assess.  Currently the APN toolkit houses no instruments that investigate structure.
  • Process examines how care has been provided in terms of appropriateness, acceptability, completeness or competency.  These measurements are typically have more grey area and are less definite than those obtained through assessing outcomes.  Instruments that assess process variables are categorized under the following headings:  communication, patient knowledge, performance appraisal and quality of care.
  • Outcomes refer to the end points of care, such as improvement in function, recovery or survival.  Outcomes are usually concrete and precisely measured.  Some drawbacks to using outcomes to evaluate care include: choosing a relevant outcome to measure and time lapse required for measurement.  As well, there are outcomes like attitudes and satisfaction that are not precisely measured.  Instruments that assess outcome variables are categorized under the following headings:  patients, health providers and organization and health system.  Each of these three types of outcomes contain unique sub-categories.  Please click on each outcome type for more information.
 Donabedian, A. (2005).  Evaluating the quality of medical care.  The Millbank Quarterly, 83, 4, 691-729.
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