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This Week’s Citation Classic - Garfield Library · This Week’s Citation Classic FEBR’UARY 7, 1983 DonabedJan A. Evaluating the quality ofmedical care. Milbank Mern. Fund Quart

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Page 1: This Week’s Citation Classic - Garfield Library · This Week’s Citation Classic FEBR’UARY 7, 1983 DonabedJan A. Evaluating the quality ofmedical care. Milbank Mern. Fund Quart

This Week’s Citation Classic FEBR’UARY 7, 1983

DonabedJanA. Evaluatingthequality of medicalcare.Milbank Mern. FundQuart. 44:166-206,1966.[Schoolof PublicHealth, Univ. Michigan, Ann Arbor, MI]

This paper is a review of quality assess-ment methods, which discusses what toassess, where the information comesfrom, the nature of the criteria andstandards, the sampling of care, and thereliability and validity of the measure-ment scales. Future work is proposed.[The Science Citation Index® (SCI®) andthe Social Sciences Citation Index®(SSCI®) indicate that this paper hasbeen cited in over 205 publicationssince 1966.)

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Avedis DonabedianSchool of Public HealthUniversity of MichiganAnn Arbor, Ml 48109

“When a student at the HarvardSchool of Public Health, I wrote apaper on quality assessment for myteacher Franz Goldmann. Soon after-ward, I became a rather junior partici-pant in a research effort, led byLeonard Rosenfeld, to develop indica-tors of need and unmet need for medi-cal care in the Boston area. A study ofthe quality of hospital care was onepart of this program of studies. ThoughI was not, myself, involved in this, Iheard a lot about the study, and musthave become intrigued by the subject. Iwas, therefore, well primed when,some years later, I was asked, I believeat Rosenfeld’s instigation, to reviewand evaluate the then rather limitedliterature on quality assessment.

“My contribution was to be only partof an ambitious project initiated by theHealth Services Research Study Sec-

tion of the US Public Health Service un-der the chairmanship of Kerr 1. White.Almost the entire field of health ser-vices research was to be scrutinized,using for the purpose a series of 15commissioned papers, each by an ex-pert in some designated part. I did notsee myself as an expert in quality as-sessment, and it became apparent atthe planning meetings of the group ofauthors and administrators that fewothers did. I had been selected perhapsbecause no one else was available, andthere was even some doubt as towhether or not the job could be done atall. I remember Richard Weinerman de-tailing the many pitfalls that I wasabout to face, and asking how I pro-posed to handle them. ‘By not fallinginto them,’ I said, throwing caution tothe wind. Saved by laughter.

“The paper came at a critical junc-ture. Efforts to assess the quality ofmedical care were beginning to gatherstrength. In another few years, thefederal government was to throw itsfull weight behind the enterprise. Andyet, there was at the time no well-or-ganized picture of what quality assess-ment meant. The paper supplied themuch needed organizing frameworkfor past and future studies of quality,and it provided the nomenclature thatpermitted intelligent discussion. Muchof the current language of qualityassessment has its roots in this paper,even though many who use the lan-guage are not aware of what a recentinvention it is.

“With two major exceptions, the pa-per proved to have been conceptuallycomprehensive as well. At that time,quite by design, I took the relationshipbetween good care and its outcomes asa given, and I excluded a considerationof monetary cost. I have since addedthese two components to a more com-prehensive model.”1

November 29, 1982

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I. Donabedlan 4. WheelerJR c & Wyazewlanskl L. Quality, cost, and health: an integrative model.Med. Care 20:975-92, 1982.

18 S&BS CURRENT CONTENTS®@1983 by ISl®