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


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Suggested Citation:"CONCLUSIONS AND SUMMARY." Institute of Medicine. 1990. Clinical Practice Guidelines: Directions for a New Program. Washington, DC: The National Academies Press. doi: 10.17226/1626.
Page 49

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DEFINITIONS OF KEY TERMS 49 the primary importance of (outcome) measures as monitors of performance. . . . [They] describe relatively precise measures of important aspects of care. . . . [They] are not clinical standards or practice guidelines." David Eddy (forthcoming): In discussing the distinction between practice policies (see the earlier section) and performance policies, he notes that performance policies address the issue of ensuring that "whatever interventions are used, are used correctly. . . . They are intended to guide or review the performance of interventions, without concern for whether the interventions should have been performed in the first place." The Committee's Provisional Definition: Performance Measures Performance measures 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. Given the multiple common meanings of the term and the paucity of professional and technical usage, the committee decided to offer only a provisional definition of performance measures. As practice guidelines and related evaluation instruments are more widely developed and used, a different or more specific meaning for this term may emerge. The committee could have considered performance measures to be a combination of standards and criteria—measures of whether a given "performance" as judged by some set of criteria meets (or exceeds or falls short of) a standard. Considered in this way, the term verges on being synonymous with the other terms defined in this chapter. Therefore, the committee chose provisionally to view performance measures as instruments (for example, questionnaires, abstracting forms, measurement scales, or computer programs) for recording or measuring data on performance. In this sense, a distinction is made between measuring and judging. Thus, a performance measure is more like a bathroom scale than it is like a table of recommended weights by gender and body build. In sum, it is probably valuable to maintain a distinction between the instrument or means of measuring something and the judging of the results. Furthermore, performance measures should be sensitive to what is not done as well as what is done. CONCLUSIONS AND SUMMARY In this chapter, the committee has proposed definitions of the four key terms used in the legislation establishing the Office of the Forum

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