Donabedian’s structure-process-outcome quality of care model

Moore, Lynne; Lavoie, André; Bourgeois, G; Lapointe, Jean

doi:10.1097/ta.0000000000000663

Cited by 116 publications

(95 citation statements)

References 22 publications

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“…[23][24][25] In health care evaluation, researchers attempt to control for such group differences by considering Donabedian's framework for factors related to structures and processes of care. 26 In this framework, the structures of care are the material resources (facilities, equipment, staffing ratios) and human resources (qualifications, experience) needed to provide care and the organizational features (systems, services, size, volume) of the care providers. The processes of care are medical procedures (diagnosis, treatment, rehabilitation) and managerial activities (transfer, scheduling, discharge planning) that constitute the care delivery within the defined structures.…”

Section: Introductionmentioning

confidence: 99%

Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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In hip fracture care, it is disputed whether mortality worsens when surgery is delayed. This knowledge gap matters when hospital managers seek to justify resource allocation for prioritizing access to one procedure over another. Uncertainty over the surgical timing-death association leads to either surgical prioritization without benefit or the underuse of expedited surgery when it could save lives. The discrepancy in previous findings results in part from differences between patients who happened to undergo surgery at different times. Such differences may produce the statistical association between surgical timing and death in the absence of a causal relationship. Previous observational studies attempted to adjust for structure, process, and patient factors that contribute to death, but not for relationships between structure and process factors, or between patient and process factors. In this article, we (1) summarize what is known about the factors that influence, directly or indirectly, both the timing of surgery and the occurrence of death; (2) construct a dependency graph of relationships among these factors based explicitly on the existing literature; (3) consider factors with a potential to induce covariation of time to surgery and the occurrence of death, directly or through the network of relationships, thereby explaining a putative surgical timing-death association; and (4) show how age, sex, dependent living, fracture type, hospital type, surgery type, and calendar period can influence both time to surgery and occurrence of death through chains of dependencies. We conclude by discussing how these results can inform the allocation of surgical capacity to prevent the avoidable adverse consequences of delaying hip fracture surgery.

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Section: Introductionmentioning

confidence: 99%

Mortality by Timing of Hip Fracture Surgery

Sobolev

Guy

2017

The Journal of Bone and Joint Surgery

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“…According to this model, healthcare quality is evaluated in terms of structure (context of the healthcare delivery), process (clinical processes followed in healthcare delivery) and outcome (effect on the patient following healthcare delivery). This model has been previously used to evaluate trauma care (Moore, Lavoie, Bourgeois, & Lapointe, 2015;Stelfox, Bobranska-Artiuch, Nathens, & Straus, 2010). Additional hypotheses and logic for the formulated questions are shown in Table 1.…”

Section: Designmentioning

confidence: 99%

Exploring patient satisfaction after operative and nonoperative treatment for midshaft clavicle fractures: a focus group analysis

Tutuhatunewa

Stevens

Dams

et al. 2020

Preprint

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Background There is no consensus on the optimal treatment for displaced midshaft clavicle fractures. Several studies indicate superior patient satisfaction in favour of operative reconstruction. It is unknown what drives superior satisfaction in this treatment group. The aim of this study was to explore patient satisfaction and identify contributors to patient satisfaction after operative and nonoperative treatment for displaced midshaft clavicle fractures in adults using a focus group approach. Methods Four face-to-face and two web-based focus groups were hosted. A total of 24 participants who were treated nonoperatively (n = 14) or operatively (n = 10) agreed to participate. Participants were selected using purposive sampling, ensuring variation in gender, age, treatment complications and outcomes. A question script was developed to systematically explore patient expectations, attitudes and satisfaction with different dimensions of care. All focus groups were voice-recorded and transcribed at verbatim. Thematic analysis was conducted on all face-to-face and web-based transcripts. Results The main emerging themes across treatment groups were; need for more information, functional recovery, speed of recovery and patient-doctor interaction. There was no difference in themes observed between operative and nonoperative focus groups. The lack of information was the most important complaint in dissatisfied patients. Conclusion Our study shows that informing patients about their injury, treatment options and expectations for recovery is paramount for overall patient satisfaction after treatment for a displaced midshaft clavicle fracture. Level of evidence: Level III, focus group study

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“…This conceptual model analyses the quality of healthcare from three dimensions: structure, process and outcome. According to this model, improvements in the structure of care should lead to improvements in clinical processes [9]. Based on the results of previous studies [10][11][12], we hypothesised relationship between the organisational characteristics and adoption of HIT is illustrated below: H1: Larger hospitals will adopt HIT more extensively than smaller hospitals.…”

Section: Research Frameworkmentioning

confidence: 99%

Estimating the impacts of hospitals’ organisational characteristics on the adoption of health information technology in Mongolian public hospitals

Zhang

Tsagaankhuu

2019

Preprint

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Background The adoption of health information technology (HIT) is an important measure for improving healthcare quality and safety effected by many hospital factors, but it has not yet been estimated in the Mongolian healthcare field. This study examines how hospitals’ organisational characteristics influence the adoption of HIT in Mongolian tertiary and secondary care public hospitals. Methods А cross-sectional study involving the executive directors and quality managers at 39 hospitals. Data came from: (1) hospitals’ organisational characteristics (Mongolian Health Statistics, 2017), including hospital size, ownership type, health maintenance organisation (HMO) penetration, and hospital location; (2) questionnaires used to collect the adoption rate of HIT and HIT categories based on the Health Information and Management Systems Society’s classification (2002). The dependent variable was measured as numbers and the rate of HIT programs adopted included clinical, administrative and strategic information technologies (IT). A regression analysis was used to estimate the factors of impact on the adoption of clinical, administrative and strategic IT. Results On average, the number of HIT programs adopted reached 18, covering nine clinical IT programs, six administrative IT programs and three strategic IT programs. The adoption rate of overall HIT ranged between 29.02–38.05% with a mean of 33.29%. Regression analysis for organisational characteristics impact on HIT adoption found that the adoption of total HIT was positively associated with large hospital size (clinical IT: β=0.256, p< .001; administrative IT: β=0.3654, p< .001; strategic IT: β=0.0006, p<.001), ownership type (strategic IT: β=1995, p< .01), urban location (clinical IT: β=0.2840, p< .001, administrative IT: β=0.2256, p< .01; strategic IT: β=0.2256, p< .001), and HMO penetration (clinical IT: β=0.2560, p< .05, administrative IT: β=0.1985, p< .05; strategic IT: β=0.2236, p< .01). Conclusion Our study found that HIT adoption rate is poor, and HIT adoption is positively associated with hospitals’ organisational characteristics, such as large size, urban location, and HMO penetration. The profit ownership only positively contributes to strategic IT adoption. We concluded that hospitals with the above structural attributes conducive to more HIT adoption.

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Donabedian’s structure-process-outcome quality of care model

Abstract: Prognostic study, level III.

Cited by 116 publications

References 22 publications

Mortality by Timing of Hip Fracture Surgery

Mortality by Timing of Hip Fracture Surgery

Exploring patient satisfaction after operative and nonoperative treatment for midshaft clavicle fractures: a focus group analysis

Estimating the impacts of hospitals’ organisational characteristics on the adoption of health information technology in Mongolian public hospitals

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