Members of the American Academy of Nursing Expert Panel on Quality Health Care, in addition to the primary authors: Margaret M. Sovie; Chair; Marjorie Beyers; C. Alicia Georges; Colleen Goode; Shirley Girouard; Susan Grobe; Suzanne B. Henry; Carole Hudgings; Katherine Jones; Norma Lang; Patricia Moritz; Mae Taylor Moss; Judith A. Ryan; Roma Lee Taunton; and Joyce Verran. Opinions expressed in this paper are those of the individual authors and do not necessarily reflect the views of the American Academy of Nursing and the U.S. Army Medical Department, Department of the Army and Department of Defense.
Quality Health Outcomes Model
Article first published online: 2 OCT 2007
Image: the Journal of Nursing Scholarship
Volume 30, Issue 1, pages 43–46, March 1998
How to Cite
Mitchell, P. H., Ferketich, S., Jennings, B. M. and American Academy of Nursing Expert Panel on Quality Health Care (1998), Quality Health Outcomes Model. Image: the Journal of Nursing Scholarship, 30: 43–46. doi: 10.1111/j.1547-5069.1998.tb01234.x
- Issue published online: 2 OCT 2007
- Article first published online: 2 OCT 2007
- Accepted for publication December 17, 1997.
- quality of health care;
- conceptual models;
- health policy
Purpose: Donabedian's 1966 framework of structure, process, and outcome has guided three decades of study in the United States of the elements needed to evaluate and compare medical care quality. Donabedian's perspective was essentially linear, assuming that structures affect processes, which in turn affect outcomes. Patient characteristics are sometimes considered as mediating outcomes and clinical interventions are considered to be processes. A model is presented in the following article that relates multiple factors affecting quality of care to desired outcomes. It extends previous models by positing dynamic relationships with indicators that not only act upon, but reciprocally affect the various components.
Scope and Sources: The proposed model was derived from a synthesis of the authors' experience in quality of care practice and research, as well as selected previous theories.
Conclusions: The quality health outcomes model is sufficiently broad (a) to guide development of databases for quality improvement and outcomes management, (b) to suggest key variables in clinical intervention research, and (c) to provide a framework for outcomes research and outcomes management that compares not only treatment options, but organizational or system level interventions. The model also has several policy implications.