explicitness, flexibility, and scientific support. Not surprisingly, criteria sets vary in their utility and acceptability.

A prerequisite for developing useful and acceptable quality-of-care criteria is a consensus on the characteristics of sound criteria sets and acceptable methods for constructing them. The immediate goal in this chapter is to propose a basis for such a consensus. The actual development and implementation of sound guidelines will require a commitment of considerable time, resources, and expertise over a period of years.

The Institute of Medicine (IOM) study committee believed that the best way for it to move toward a framework for developing sound criteria was to convene a panel of respected experts in guideline formulation from various organizations active in this field. The main purpose of the panel was to reach agreement on the desirable attributes of quality-of-care criteria. These attributes would be standards against which old or newly developed criteria could be compared and evaluated. The panel’s focus was thus on the formulation of “criteria for judging criteria” rather than on the endorsement of specific sets of criteria. Appendix A describes the composition and activities of the panel.

The remainder of this chapter discusses the conceptual issues presented to the panel. These included: three types of quality-of-care criteria sets, the range of attributes and characteristics that might be considered desirable or necessary for such criteria sets to have, the uses to which such criteria sets can be put in a quality assurance context (such as education or quality review), and key attributes for such criteria sets.

Producing criteria sets that meet the standards proposed by the panel calls for a complex and sophisticated development strategy, or perhaps several strategies depending on the type of criteria set in question. Later sections of this chapter briefly discuss methods for developing criteria with particular emphasis on stages in the development process, priority-setting, and affordability.

TYPES OF CRITERIA SETS

Different kinds of criteria sets have evolved to meet different needs. The expert panel identified three broad types: appropriateness guidelines, patient care evaluation and management criteria, and case-finding screens. Each of these is discussed below.

Appropriateness Guidelines

Appropriateness guidelines describe accepted indications for using particular medical interventions and technologies, ranging from surgical procedures to diagnostic studies. Some guidelines specify under what circum-



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