From Structure to Outcome: The Role of the Donabedian Model in Global Health Service Management Research (1987–2024)

¹ Faculty of Public Health, Universitas Jember, Jember, East Java, Indonesia
² Faculty of Public Health, Universitas Diponegoro, Semarang, Indonesia
³ Universitas Jember, Jember, East Java, Indonesia
⁴ Universitas Jember, Jember, East Java, Indonesia
⁵ Department of Public Health, Medical Faculty, University of Jember, East Java, Indonesia

^* Corresponding author: krishnaufal@unej.ac.id

Abstract

The Donabedian model—first introduced in 1966—remains the primary foundation for evaluating the quality of health care through three components: structure, process, and outcomes. Although its application has expanded globally, comprehensive mapping of its scientific evolution is still limited. This study aims to explore research trends, conceptual developments, and scientific collaboration networks related to the Donabedian model in healthcare management using bibliometric and scientometric approaches. Data were collected from the Scopus database (1987–2024) and analyzed using BiblioShiny for descriptive exploration, VOSviewer for visualization of co-ocracy networks, and CiteSpace for detecting citation bursts and thematic evolution. The results show a surge in publications since 2015 influenced by value-based service reforms and the global health agenda. Developed countries such as the United States, Canada, and Australia dominate publications, accompanied by increasingly active contributions from low- and middle-income countries such as Ethiopia, reflecting a more inclusive flow of knowledge exchange. The CiteSpace analysis identified 11 thematic clusters, ranging from neonatal care to system transformation and palliative services, demonstrating the conceptual maturity and multidisciplinary relevance of these models. Seminal articles such as Donabedian (1988, 2003) and Crossing the Quality Chasm (2001) occupy a central position in the co-citation network, connecting various research domains. Overall, the study confirms that the Donabedian model has evolved into a cross-contextually adaptive scientific meta-framework and a strategic instrument in equitable and contextual health system reform.