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DEFINITIONS OF KEY TERMS 46 Professional and Technical Usage AMA (J. Kelly, director of the Office of Quality Assurance, letter dated April 26, 1990): A standard is an ''accepted principle for patient management." IOM (1974:28): "A 'standard' is the degree of adherence to the defined criteria." Joint Commission on Accreditation of Healthcare Organizations (1989a): "expectations or rules relating to the structures or processes necessary for delivery of patient care." PSRO Manual (cited in Donabedian, 1981): "Standards are professionally developed expressions of the range of acceptable variation from a norm or criterion." Mark Chassin (1988:438â439): Chassin refers to "standards of care or practice guidelines" and goes on to say that "[t]hey can also define several levels of quality of care, from the best attainable to a minimal level below which care is unacceptably poor. They can also be applied to groups of patients as well as to individuals." David Eddy (forthcoming): In distinguishing standards, guidelines, and options for "practice policies," Eddy makes the following point: "A practice policy is considered a standard if the health and economic consequences of an intervention are sufficiently well known to permit meaningful decisions and there is virtual unanimity among patients about the desirability (or undesirability) of the intervention, and about the proper use (or nonuse) of the intervention." (That is, a standard is the most stringent form of a practice policy.) Healther Palmer and Miriam Adams (forthcoming): Standards are "professionally developed expressions of the range of acceptable variation from norms or criteria." Palmer goes on to say "commonly, all-or-nothing standards (for example, 100 percent or 0 percent compliance required) are preferred. This is coupled with peer review of all cases that vary from the criteria." Virgil Slee (1974): "The desired achievable (rather than the observed ) performance or value with regard to a given parameter." (emphasis in original) Parameter is then defined as "an objective, definable, and measurable characteristic of the patient himself or of the process or outcome of his care. Each parameter has a scale of possible values. . . ." Hannu Vuori (1989:156): "A standard is the value of a criterion that indicates the border between acceptable and poor quality. Standards can be normative or empirical.7 A normative standard equates the acceptable performance with either the best imaginable performance or the best attainable performance under ideal circumstances. Empirical standards are 7 Connotations derived from "norm" and "normative" cause endless problems. Some experts,