[6] 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.
[5] Donabedian developed his quality of care framework to be flexible enough for application in diverse healthcare settings and among various levels within a delivery system.
At its most basic level, the framework can be used to modify structures and processes within a healthcare delivery unit, such as a small group practice or ambulatory care center, to improve patient flow or information exchange.
For instance, health administrators in a small physician practice may be interested in improving their treatment coordination process through enhanced communication of lab results from laboratorian to provider in an effort to streamline patient care.
The structure could involve an electronic health record (EHR) that a laboratorian fills out with lab results for use by the physician to complete a diagnosis.
To improve this process, a healthcare administrator may look at the structure and decide to purchase an information technology (IT) solution of pop-up alerts for actionable lab results to incorporate into the EHR.
For example, systemic lupus erythematosus (SLE) is a condition with significant morbidity and mortality and substantial disparities in outcomes among rheumatic diseases.
[10] These indicators supply health care leaders with data to evaluate the organization’s performance in order to design strategic QI planning.
The sequential progression from structure to process to outcome has been described by some as too linear of a framework,[12] and consequently has a limited utility for recognizing how the three domains influence and interact with each other.
[14] Coyle and Battles suggest that these factors are vital to fully understanding the true effectiveness of new strategies or modifications within the care process.
[16] “Evaluating the Quality of Medical Care” became one of the most frequently cited public health-related articles of the 20th century, and the Donabedian Model gained widespread acceptance.