Send to

Choose Destination
See comment in PubMed Commons below
Image J Nurs Sch. 1998;30(1):43-6.

Quality health outcomes model. American Academy of Nursing Expert Panel on Quality Health Care.

Author information

  • 1Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle 98195-7266, USA.



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.


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.


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.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Loading ...
    Support Center