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DEFINITIONS OF KEY TERMS 33 2 Definitions of Key Terms "When I use a word," Humpty Dumpty said, in rather a scornful tone, "it means just what I choose it to meanâneither more nor less." "The question is," said Alice, "whether you can make words mean so many different things." "The question is,'' said Humpty Dumpty, "which is to be masterâthat's all." Lewis Carroll, Through the Looking Glass If AHCPR and the Forum are to proceed confidently with their mission, they need clear, broadly acceptable definitions of four key terms, which were used in the legislation establishing the agency: (1) practice guidelines, (2) medical review criteria, (3) standards of quality, and (4) performance measures. Neither the final legislation nor preceding House or Senate bills offered definitions of these concepts. The four key terms employed in OBRA 89 have been defined and used in quite disparate ways. Words like guidelines and standards may mean one thing to clinicians, another to purchasers, and yet another to attorneys. (The study directors for this project discovered early in their work that they were using these terms differently.) Moreover, the same person may use the same term differently in different contexts. Table 2-1 suggests how context influences usage and terminology. Further complicating the semantic and conceptual situation are other frequently used terms that are not mentioned in the legislationâterms
