Table 2.

Donabedian Model for Assessing Quality of Virtual Care

STEEEP framework	Structure	Process	Outcome
General	Local site committee/group docks into central team and central committee	Identification of general virtual care quality concerns for proactive mitigation Local trend review and forwarding to enterprise committee for aggregation, issue identification, discussion, and remediation	Track STEEEP outcome data (eg, virtual care patient experience survey)
Safety	•Local team: local site-based patient safety teams •Health system team: quality collaboration team •Health system committee: patient safety steering committee, supplemented with site-level reps in ambulatory safety, ambulatory operations & health system virtual care	•Discuss capturing virtual care safety events and how to “define” them in the safety reporting system •Identify general virtual care safety risks and coordinate proactive risk mitigation (eg, cybersecurity/delay in diagnosis/poor interaction) Local teams review and discuss cases/trends at patient safety steering committee for health system aggregation and remediation	•Track total number or reported safety events related to virtual care •Track number of safety events by category (eg, classify events vs events with true harm) Evaluate safety event spikes to try and determine whether true signal vs increases in reporting
Patient-centeredness	•Local team: site-based patient experience teams •Health system team: quality collaboration team Health system committee: patient experience leaders committee	•Identify general virtual care patient experience concerns and coordinate proactive risk mitigation Local teams review local data and patient experience leaders review system trends and specific service issues for health system remediation	•Virtual care patient experience survey scores alone and in comparison, to office survey scores Consider Net Promoter Score vs other key metrics

STEEEP, Safe, Timely, Effective, Efficient, Equitable, and Patient Centered.

Donabedian model for assessing quality of virtual care expressed as a general framework, and then populated for the Institute of Medicine domains of quality. Two illustrative examples are provided for safety and patient-centeredness.