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Glossary Clinical condition a set of identifiable clinical signs and symptoms affecting the health status of an individual. Cost-effectivenessanalyses that compare the relation of the dollar cost of health services to the resultant health benefit in teens of lives saved, disability avoided, quality-adjusted life years saved, or other relevant objectives (Weinstein and Statson, 1977; Office of Technology Assess- ment, 1980; Institute of Medicine, 198Sa). Cross-cutting technolog~a medical technology that may be used for multiple cI~rucal conditions at different stages, e.g., prevention, screening, diagnosis, or treatment. Device any physical item, excluding drugs, designed to serve a special medical function; included are diagnostic, therapeutic, and rehabilitative equipment and products, e.g., prostheses, surgical and medical instru- ments, and supplies (Office of Technology Assessment, 1978; Institute of Medicine, 1985a). Diagnosis an activity designed to identify or exclude possible causes for a clinical condition. Drugany chemical or biological substance that may be applied, in- gested, inhaled or injected to prevent, diagnose, or treat a clinical condi- tion; included are pharmaceutical preparations, genetically engineered products, and naturally occumng substances (Office of Technology As- sessment, 1978; Institute of Medicine, 198Sa). Effectiveness the health benefit from a medical technology under aver- age conditions of use, in contrast to the efficacy under ideal conditions of use(Off~ceofTechnology Assessment, 1978;InstituteofMedic~ne, 1985a). 105

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106 NATIONAL ASSESSME~TPR)~ORmES Effectiveness research the evaluation of actual clinical practice under ordinary circumstances by average practitioners for typical patients (Lohr, 19881. Efficacy Me health benefit to individuals in a defined population from a medical technology applied for a given medical problem under ideal conditions of use (Office of Technology Assessment, 1978; Institute of Medicine, 1985a). Emerging technolog~a technology that is at Me applied research stage of initial clinical testing, when Me prototype has been built (for a device) or described (for a procedure) and the technology is used mostly by its developers (Institute of Medicine, 1985a). Established technology a technology that is in widespread use and con- sidered by practitioners as the accepted or standard practice (Institute of Medicine, 1985a). Health status the baseline, normal functional, emotional, and mental condition of an individual Bohr and Mock, 19891. Meccas technology the drugs, devices, and procedures used by Cal clans In delivenng medical care to patients, and We support and organiza- tional systems within which such care is delivered (Office of Technology Assessment, 1978; Institute of Medicine, 1985a). New technology a technology that is past the stage of clinical trials and is used or tested by practitioners other than its developers but is not in widespread use Onstitute of Medicine, 1985a). Obsolete technology a technology Mat has been superseded by other technologies or has been abandoned by most practitioners Onstitute of Medicine, 1985a). Organizational syste~a technology used in the management and ad- ministration of health care; included are altemative delivery modes or settings (e.g., health maintenance organizations, area-wide emergency care systems, home heals delivery), and payment systems (e.g., prospec- tive payment using diagnosis-related groups) (Office of Technology As- sessment, 1978; Institute of Medicine, 198Sa).

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GLOSSARY 107 Patient outcomes the range of results that proceed from (or are pre- sumed to be associated with) the provision of health care services, and which include emotional, fimcdonal, mend, physiological, and social dimensions of health Bohr, 19881. Patient outcomes research systematic evaluation of aB outcomes relevant ~ patients, such as modality, morbidity, complications, symbol tom reduction and functional status improvement, that may be associated with the use of altemative medical interventions (Wennberg, 1990~. Prevention an activity designed to prevent a clinical condition from occumng or to reduce the likelihood of its occurrence. Procedureany practice of a heath care practitioner that involves a combination of special skins and that may or may not require thugs and/or devices; included are physical and cognitive procedures, e.g., medical and surgical procedures, psychotherapy, health status assessment, and patient counseling (Office of Technology Assessment, 1978; Institute of Medi- cine, 1985a). Screening an activity designed to identify an individual at high risk of a clinical condition or who has the condition but has not sought medical attention for it. Support system technology Bat facilitates and provides Be env~ron- ment for delivery of care in a health care facility but is not the focal Snag, device, or procedure used, e.g., medical infonnation systems and ancil- lary services such as laboratory and blood banking services, and infection con=} programs (Office of Technology Assessment, 1978; Institute of Medicine, 1985a). Treatment the restoration, maintenance, or unprovement of health status, encompassing attempted cure, care, and rehabilitation from the impa~r- ments associated with a clinical condition.