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

Chapter: Professional and Technical Usage

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Suggested Citation:"Professional and Technical Usage." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 43

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DEFINITIONS OF KEY TERMS 43 Professional and Technical Usage AMA (J. Kelly, director of the Office of Quality Assurance, letter dated April 26, 1990): Review criteria are "bases for evaluating quality and appropriateness of medical care." IOM (1974:28): "'Criteria' are identifiable elements of care used to judge the appropriateness of that care. . . ." Professional Standards Review Organization (PSRO) Manual (cited in Donabedian, 1981): Medical care criteria are predetermined elements against which aspects of the quality of medical services may be compared. Avedis Donabedian (1981:411): Although he apparently wishes to avoid use of the term criterion, Donabedian notes that it could usefully be employed to mean "an element or attribute that is to be used in evaluation, and that often comes accompanied by an explicit or implicit norm. . .or, even, by a standard." Elsewhere (p. 410), he says criteria are "discrete, clearly definable, and precisely measurable phenomena that belong within the categories of process or of outcome, and that, in some specifiable way, are relevant to the definition of quality." Kathleen Lohr and Robert Brook (1981:761–762): "Quality-of-care criteria are commonly characterized in several ways. One is whether they are explicit (i.e., stated in detail in advance) or implicit (i.e., based on judgments of experts without direct reference to a priori standards). . . . Criteria may be thought of as minimal, average, or ideal. . . . [M]inimal criteria place a base under which the care-giver should not fall, lest the individual be judged as practicing severely substandard care. Those who fall below this level might well be classified as outliers. Average criteria represent a community standard; they are often thought of as a range within which care is considered acceptable. The lower bound [of average criteria] is likely to be the minimal point. . . . The upper bound is likely to be a fairly high, 'ideal' point toward which the profession may simply aspire." Heather Palmer and Miriam Adams (forthcoming): Criteria are "predetermined elements of care against which aspects of the quality of a medical service may be compared." Prescriptive criteria are "criteria written by asking providers to decide what ought to be done in a given circumstance. Physicians writing such criteria have been found sometimes to specify care at an unrealistically high level. Also called normative criteria." (emphasis in the original) Hannu Vuori (1989:156): "Criteria of good care are structural elements of care or procedures to be performed and information to be gathered when treating a patient with a given problem. . .or outcomes of care." Moreover, Vuori states that "criteria. . .identify the most important elements of good care. . . ."

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