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DEFINITIONS OF KEY TERMS 45 considered by the Forum for guidelines development (see the list presented in Chapter 1), the agency may find, for example, that medical review criteria are easier to develop from the cataracts guidelines than from the guidelines for treatment of depression in the community setting. Similarly, the guidelines for managing incontinence may give rise to criteria for reviewing quality but none for making payment decisions. STANDARDS OF QUALITY The term standards is particularly difficult to clarify. In common parlance it is often used synonymously with criteria; in the quality assurance lexicon, however, it has rather different connotations. Even in everyday use, standard has many different senses. Common Usage: The Dictionary The Random House Dictionary offers more than 25 meanings including the following: "1. something considered by an authority or by general consent as a basis of comparison; an approved model. . . 3. a rule or principle that is used as a basis for judgment. . . 4. an average or normal requirement, quality, quantity, level, grade, etc. . . . 24. of recognized excellence or established authority; and 25. usual, common, customary." This dictionary suggests that a standard differs from a criterion in that the former implies a model against which the quality or excellence of other things may be determined ("she could serve as the standard of good breeding") whereas the latter does not ("wealth is not a criterion of a person's worth"). The OED sets forth the following different meanings and definition for standard (some of which are centuries old): "1. the exemplar of a measure or weight; 2. a normal uniform size or amount; a prescribed minimum size or amount; 3. an authoritative or recognized exemplar of correctness, perfection, or some definite degree of any quality (which can be construed as a rule, principle, or means of judgment or estimation, or a criterion or measure); and 4. a definite level of excellence, attainment, wealth, or the like, or a definite degree of any quality, viewed as a prescribed object of endeavour or as the measure of what is adequate for some purpose." The most troublesome aspect of common usage is the use of standard in quite different ways to describe either a minimum acceptable state or a state of high achievement and excellence. The same difficulty also shows up in the health services literature.