Question

Discuss the three pillars of Donabedian’s model for healthcare quality assurance. Does this model have practical applications today, given the current focus on healthcare value?

Answer 1

Answer:

three pillars of Donabedian’s model for healthcare quality assurance.:

process, structure, outcomes

Quality was initially described by Avedis Donabedian as consisting of 3 important dimensions

Structure refers to facilities and health care professionals providing care

Process refers to the set of services provided

Outcomes refer to the end results that people experience and care about

Numerous studies examining the process and outcomes of care demonstrated substantial variations in clinical practice, itself an indicator of questionable quality, and resulted in a movement to develop better methods for determining the relationship between care processes and outcomes. Led to the establishment of AHRQ.

The total medical cost for the payer divided by the number of “member months.” Member months the summation of the number of months members have been enrolled in a plan during the year.

Cost PMPM divided by the premium revenue PMPM, called the medical loss ratio (MLR), is the percentage of the insurer’s revenue consumed by medical costs. If an insurer’s MLR is 80%, then 80% of the insurer’s premium revenue is being used for medical costs, and the remaining 20% is available for administrative costs and the insurer’s profit.

“Units of service PMPM” are calculated for selected activities, such as physician visits or prescriptions filled – all on a PMPM basis.

“Units of service per thousand members (lives),” commonly referred to as simply “x per thousand.” These figures may be calculated for such services as inpatient hospital days, prescriptions, or hospital discharges – all expressed as “per thousand.”

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