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DEFINITIONS OF KEY TERMS 50 for Quality and Effectiveness in Health Care. The committee sought definitions that were, insofar as possible, parsimonious, consistent with common and professional usage, practically and symbolically acceptable to important interests, not easily misused, and not tautological. The list below recapitulates the committee's definitions of practice guidelines, medical review criteria, standards of quality, and performance measures. ⢠PRACTICE GUIDELINES are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. ⢠MEDICAL REVIEW CRITERIA are systematically developed statements that can be used to assess the appropriateness of specific health care decisions, services, and outcomes. ⢠STANDARDS OF QUALITY are authoritative statements of (1) minimum levels of acceptable performance or results, (2) excellent levels of performance or results, or (3) the range of acceptable performance or results. ⢠PERFORMANCE MEASURES (provisional) are methods or instruments to estimate or monitor the extent to which the actions of a health care practitioner or provider conform to practice guidelines, medical review criteria, or standards of quality. For other organizations and other purposes, different terms and definitions may serve better as long as they are clearly stated. This committee neither expects nor wishes to dictate terminology. Its objective is modest: to provide clear definitions of key terms that the Forum can use in carrying out its legal responsibilities with a minimum of confusion or provocation. Definitions, however, are only the starting point. The Forum also needs to distinguish good guidelines from bad and to communicate its expectations to contractors, expert panels, and others. The next chapter is a first step in that process. REFERENCES Chassin, M.R. Standards of Care in Medicine. Inquiry 25(Winter):437-450, 1988. Compact Edition of the Oxford English Dictionary. Oxford, England: Oxford University Press, 1971. Donabedian, A. Criteria, Norms and Standards of Quality: What Do They Mean? American Journal of Public Health 71:409-412, 1981. Eddy, D. A Manual for Assessing Health Practices and Designing Practice Policies (draft dated May 31, 1989). American College of Physicians, forthcoming. See also the articles cited in Chapter 1 of this report. Havighurst, C. Practice Guidelines for Medical Care: The Policy Rationale. St. Louis University Law Journal, forthcoming. Institute of Medicine. Advancing the Quality of Health Care. Washington, D.C.:National Academy Press, 1974.
DEFINITIONS OF KEY TERMS 51 Institute of Medicine. Controlling Costs and Changing Patient Care? The Role of Utilization Management, B. Gray and M. Field, eds. Washington, D.C.:National Academy Press, 1989. Institute of Medicine. Medicare: A Strategy for Quality Assurance, vols. 1 and 2, K. Lohr, ed., Washington, D.C.: National Academy Press, 1990. Joint Commission on Accreditation of Healthcare Organizations. A National Invitational Forum on Clinical Indicator Development, Chicago, March 1989a. Joint Commission on Accreditation of Healthcare Organizations. Statement before the House Subcommittee on Health, Committee on Ways and Means, concerning the Medical Care Quality Research Act of 1989. Washington, D.C., May 24, 1989b. Leape, L. Practice Guidelines and Standards: An Overview. Quality Review Bulletin 16:42-49, 1990. Lohr, K.N., and Brook, R.H. Quality Assurance and Clinical Pharmacy: Lessons from Medicine . Drug Intelligence and Clinical Pharmacy 15:758-765, 1981. Meyer, H. Medicine Debates Parameters (Or Are They Guidelines?). American Medical News, December 15, 1989, p. 36. Palmer, R.H., and Adams, M. Considerations in Defining Quality of Health Care. In Perspectives on Quality Assurance. Ann Arbor, Mich.: Health Administration Press, forthcoming. Park, R.E., Fink, A., Brook, R.H., et al. Physician Ratings of Appropriate Indications for Six Medical and Surgical Procedures. R-3280-CWF/HF/PMT/RWJ. Santa Monica, Calif.: The RAND Corporation, 1986. Physician Payment Review Commission. Improving the Quality of Care: Clinical Research and Practice Guidelines. Appendix 1, Background Paper for Conference, October 1988; draft dated September 28, 1988a. Physician Payment Review Commission. Increasing Appropriate Use of Services: Practice Guidelines and Feedback of Practice Patterns. Chapter 13 in Annual Report to Congress. Washington, D.C., 1988b. Random House Dictionary of the English Language, 2nd ed., unabridged. New York: Random House, 1987. Slee, V. PSRO and the Hospital's Quality Control. Annals of Internal Medicine 81:97-106, 1974; cited in Donabedian (1981). U.S. Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions. Baltimore, Md.: Williams & Wilkins, 1989. Vuori, H. Research Needs in Quality Assurance. Quality Assurance in Health Care 1:147-159, 1989.
