Evaluating the Quality of Health Care

7. Structure Measures

Probably the main advantage and attractiveness of structure measures is that they are concrete and usually easy to assess. For example, it is relatively easy to determine whether an intensive care unit has a specialty physician available 24 hours a day or if a health plan provides incentives to physicians who meet high standards of care, the training of physicians (Landon, et al., 2003; Landon, et al., 2002), whether a clinic specializes in particular types of care (Wilson, IB., et al., 2005), or the number of procedures performed per year (Hannan, et al., 1997).

Structural characteristics that did not receive a great deal of attention when Donabedian did his seminal research include organizational culture, including to the priority that a clinic or hospital gives to quality as well as leadership, policies and procedures for maximizing the quality of care (Berwick, 1996; Institute of Medicine, 2001)

The main disadvantage of such measures is that often the association between structure and process and/or structure and outcome are not well-established and developing evidence for such associations is difficult. One of the reasons for this is that the link between structure and process or outcome measures of quality are often very complex (Landon, Wilson, & Cleary, 1998) and consequently weak (Landon, Zaslavsky, Beaulieu, Shaul, & Cleary, 2001). Another weakness is that the most accessible structural variables often lack specificity. For example, one can relatively easily determine if a person is board certified in infectious diseases but it is much harder to develop a measure of the quality of that training or the extent to which the physician uses that knowledge or skills.

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington D.C.: National Academy Press.