Evaluating the Quality of Medical Care
AV E D I S D O N A B E D I A N
his paper is an attempt to describe and evaluate current methods for assessing the quality of medical care and to suggest some directions for further study. It is concerned with methods rather than findings, and with an evaluation of methodology in general, rather than a detailed critique of methods in specific studies. This is not an exhaustive review of the pertinent literature. Certain key studies, of course, have been included. Other papers have been selected only as illustrative examples. Those omitted are not, for that reason, less worthy of note. This paper deals almost exclusively with the evaluation of the medical care process at the level of physician-patient interaction. It excludes, therefore, processes primarily related to the effective delivery of medical care at the community level. Moreover, this paper is not concerned with the administrative aspects of quality control. Many of the studies reviewed here have arisen out of the urgent need to evaluate and control the quality of care in organized programs of medical care. Nevertheless, these studies will be discussed only in terms of their contribution to methods of assessment and not in terms of their broader social goals. The author has remained, by and large, in the familiar territory of care provided by physicians and has avoided incursions into other types of
The Milbank Quarterly, Vol. 83, No. 4, 2005 (pp. 691–729) c 2005 Milbank Memorial Fund. Published by Blackwell Publishing.
Reprinted from The Milbank Memorial Fund Quarterly, Vol. 44, No. 3, Pt. 2, 1966 (pp. 166–203). Style and usage are unchanged.
health care. Also, consideration of the difficult problem of economic efficiency as a measurable dimension of quality has been excluded. Three general discussions of the evaluation of quality have been very helpful in preparing this review. The first is a classic paper by...