Celebrating Avedis Donabedian’s Seminal Article Published 50 Years Ago in The Milbank Quarterly

Events and publications have marked the 50^th anniversary of the publication of Avedis Donabedian’s seminal article on quality measurement. Donabedian, a professor at the University of Michigan School of Public Health, published the paper, “Evaluating the Quality of Medical Care,” in The Milbank Quarterly in 1966—and his structure- process-outcome framework for health care quality measurement has guided generations of health care researchers and practitioners since then.

Commemorating the occasion, Howard Markel, Editor-in-Chief of The Milbank Quarterly, with John Z. Ayanian, published a Perspective for the New England Journal of Medicine on “Donabedian’s Lasting Framework for Health Care Quality.” In the paper, the authors take an historical and personal look at Donabedian’s legacy, focusing on how Donabedian’s background as a Lebanese immigrant and a nonpracticing physician gave him the kind of “outside” perspective that informed his life-long interest in the ways in which medical care is delivered. Donabedian’s contribution to “a new era of health care” was further explained in a University of Michigan article.

The June issue of The Milbank Quarterly featured an op-ed by Donald Berwick of the Institute for Healthcare Improvement and Daniel M. Fox, president emeritus of the Milbank Memorial Fund, about the seminal paper. This “masterpiece,” they write, which is the Milbank Quarterly’s most frequently cited article, covers “the entire field of quality measurement as it was understood at the time.”

“Avedis would be smiling in celebration if he were here,” said Berwick, who led a panel discussion at the AcademyHealth Annual Research Meeting in June about Donabedian’s contributions to the field of health services research.

The panel, “Beyond Structure, Process, and Outcome: Reflections on 50 Years Since the Donabedian Model,” featured speakers Carolyn Clancy, Department of Veteran Affairs; Helen Burstin, National Quality Forum; Lucian Leape, Harvard University; Maureen Bisognano, Institute for Healthcare Improvement; and Donald Berwick. Addressing a packed audience, the panelists spoke about the framework Donabedian offered in 1966 as well as what the future might hold for the pursuit of quality. Panel members agreed that while the science of health care quality improvement continues to evolve, Donabedian’s work retains both its relevance and authority. Panel members encouraged those in attendance to read (and reread) his original 1966 paper, available here.