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Donabedian model. The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [ 1] According to the model, information about quality of care can be drawn from three categories: “structure,” “process,” and “outcomes." [ 2] Structure describes the context in ...
Andersen healthcare utilization model. The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing ...
Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Uncertainty management theory ( UMT ), developed by Dale Brashers, addresses the concept of uncertainty management. Several theories have been developed in an attempt to define uncertainty, identify its effects and establish strategies for managing it. [ 1] Uncertainty management theory was the first theory to decline the idea that uncertainty ...
Increasing or decreasing one results in changes to one or both of the other two. For example, a policy that increases access to health services would lower quality of health care and/or increase cost. The desired state of the triangle, high access and quality with low cost represents value in a health care system.
Evidence-based medicine ( EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." [ 1] The aim of EBM is to integrate the ...
The biomedical model of medicine care is the medical model used in most Western healthcare settings, and is built from the perception that a state of health is defined purely in the absence of illness. [ 1]: 24, 26 The biomedical model contrasts with sociological theories of care. [ 1]: 1 [ 2] Forms of the biomedical model have existed since ...
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("managed care techniques"). It has become the predominant system of delivering and receiving American ...