Donabedian Approach for Simulation Modeling to Evaluate the Quality of Emergency Medical Services in a Large Metropolitan Area: A Case Study

This study was carried out in order to develop a simulation model for a complex assessment of the quality of emergency medical services in a large metropolitan area. The study methods are based on the Donabedian model, a conceptual model that provides a framework for evaluating the quality of health care and emergency medical services. According to the Donabedian model, information about the quality of care can be drawn from three categories: the quality of structure, the quality of the process, and the quality of outcomes. The fourth category - environmental quality - is proposed to be added to the model in order to consider the specifics of emergency medical services in a large metropolitan area. The proposed conceptual model for the quality of emergency medical services defines the approach to emergency medical services modeling, i.e. creating a set of submodels that would allow assessing all the quality categories for emergency medical services. The paper includes a case study for such a model that combines methods from system dynamics and agent-based modeling. The study results can be used for health care institution modeling in order to lay down recommendations regarding how the health care institution management strategy can be improved.