According to Donabedian, what are the three types of performance measures?

• A. Structure and Outcome measures
• B. Input, Output, and Outcome measures
• C. Structure, Process, and Outcome measures
• D. Process, Technology, and Staffing measures

Answer: (C)

Donabedian’s framework for evaluating healthcare quality groups performance into three domains: Structure, Process, and Outcome. Structure covers the settings and resources that enable care—facilities, equipment, staffing, and organizational policies. Process refers to what actually happens during care—the actions taken by providers and patients, such as diagnosis, treatment decisions, guideline adherence, and patient education. Outcome looks at the results of care on health status—improvements in condition, recovery, functional status, mortality, and patient experience.

This triad is the best fit because it separates the environment and resources from the care actions and from the results, giving a comprehensive view of quality. The other options miss or mix these domains, such as omitting Process, using non-Donabedian terms like input/output, or focusing on technology or staffing alone without the full structure-process-outcome perspective. For example, you can measure structure with nurse-to-patient ratios, process with timely antibiotic administration, and outcome with infection rates or patient-reported outcomes, illustrating how each domain contributes to overall quality.