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The Donabedian Model Cheat Sheet by

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The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care.

According to the model, inform­ation about quality of care can be drawn from three catego­ries: “struc­ture,” “process,” and “outco­mes­". Structure describes the context in which care is delivered, including hospital buildings, staff, financing, and equipment. Process denotes the transa­ctions between patients and providers throughout the delivery of health­care. Finally, outcomes refers to the effects of healthcare on the health status of patients and popula­tions. Avedis Donabe­dian, a physician and health services researcher at the University of Michigan, developed the original model in 1966. The Donabedian Model continues to be the dominant paradigm for assessing the quality of health care.


Structure includes all the factors that affect the context in which care is delivered. This includes the physical facility, equipment, and human resources, as well as organi­zat­ional charac­ter­istics such as staff training and payment methods. These factors control how providers and patients in a healthcare system act and are measures of the average quality of care within a facility or system. Structure is often easy to observe and measure and it may be the upstream cause of problems identified in process


Process is the sum of all actions that make up health­care. These commonly include diagnosis, treatment, preventive care, and patient education but may be expanded to include actions taken by the patients or their families. Processes can be further classified as technical processes, how care is delivered, or interp­ersonal processes, which all encompass the manner in which care is delivered.

According to Donabe­dian, the measur­ement of process is nearly equivalent to the measur­ement of quality of care because process contains all acts of healthcare delivery. Inform­ation about process can be obtained from medical records, interviews with patients and practi­tio­ners, or direct observ­ations of healthcare visits.

Donabedian Model


Outcome contains all the effects of healthcare on patients or popula­tions, including changes to health status, behavior, or knowledge as well as patient satisf­action and health­-re­lated quality of life. Outcomes are sometimes seen as the most important indicators of quality because improving patient health status is the primary goal of health­care. However, accurately measuring outcomes that can be attributed exclus­ively to healthcare is very difficult.

Drawing connec­tions between process and outcomes often requires large sample popula­tions, adjust­ments by case mix, and long-term follow ups as outcomes may take consid­erable time to become observ­able.


Although it is widely recognized and applied in many health care related fields, the Donabedian Model was developed to assess quality of care in clinical practice. The model does not have an implicit definition of quality care so that it can be applied to problems of broad or narrow scope.

Donabedian notes that each of the three domains has advantages and disadv­antages that necess­itate resear­chers to draw connec­tions between them in order to create a chain of causation that is concep­tually useful for unders­tanding systems as well as designing experi­ments and interv­ent­ions.

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