National Academies Press: OpenBook

Clinical Practice Guidelines: Directions for a New Program (1990)

Chapter: Common Usage: The Dictionary

Suggested Citation:"Common Usage: The Dictionary." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 42

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DEFINITIONS OF KEY TERMS 42 with specific clinical characteristics); at other times they may focus on patterns of care (for example, to compare rates of hysterectomies for groups of patients with similar clinical characteristics). Because the committee was not asked to provide principles for translating guidelines into evaluation instruments, it did not give in-depth consideration to the issues the Forum may face in moving from a given set of practice guidelines to the corresponding evaluation instruments. The committee did not, for example, discuss whether different principles and translation strategies might be needed for guidelines that focus heavily on nursing care compared to those that mainly emphasize care provided by physicians. The recent IOM report on quality assurance in the Medicare program (1990) discusses some of the attributes that good review criteria should have. Given the expectations that guidelines will be used to improve the quality and effectiveness of health care, the task of clearly translating guidelines into evaluation tools is a critical one that needs to be considered during the process of guidelines development rather than at its end. At this early stage in the Forum's work, however, it may not be feasible for each set of guidelines to be accompanied by all three types of evaluation instruments.5 As the Forum and its expert panels tackle specific decisions about evaluation instruments, they may well suggest some adjustments in the definitions offered below. This seems a possibility in particular for the definition of standards of quality and the provisional definition of performance measures, both of which gave the committee substantial difficulty in their formulation. MEDICAL REVIEW CRITERIA Common Usage: The Dictionary According to the Random House Dictionary, a criterion is "a standard of judgment or criticism; a rule or principle for evaluating or testing something." The OED offers three definitions: an organ, faculty, or instrument of judging; a test, principle, rule, canon, or standard, by which anything is judged or estimated; and a distinguishing mark or characteristic, attaching to a thing, by which it can be judged or estimated. 5 For the initial set of conditions for which guidelines are due by January 1, 1991, OBRA 89 is somewhat inconsistent about what is required of the Forum. Section 912(d) of the law (part of the amendments to the Public Health Service Act) calls for the development of guidelines, standards, performance measures, and review criteria, whereas section 1142(a)(3)(A) requires only guidelines.

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