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SUMMARY 8 of practice guidelines may in the end be fairly modest. Indeed, the contemporaneous efforts of many different organizations in the private sector may significantly outpace what this one agency can do. The predominance of the private sector should be even greater for guidelines implementation, where most initiative must rest with private organizations and individuals. Even when the government plays the principal role in funding and disseminating guidelines on certain topics or clinical conditions, these guidelines will be tailored or adjusted by providers, health plans, and others to reflect different patient populations, delivery settings, practitioner skills and attitudes, levels of resources, perceptions of risk, and other factors. The committee expects that the processes of guidelines development, implementation, and evaluation will always need to be pursued by both the public and private sectors. RECOMMENDATIONS: DEFINITIONS If the Forum is to proceed confidently with its mission, it needs clear and broadly acceptable definitions of four key terms used in OBRA 89: (1) practice guidelines, (2) medical review criteria, (3) standards of quality, and (4) performance measures. Neither the final legislation nor preceding House or Senate bills offered definitions of these particular terms, and the literature on practice guidelines and related topics is characterized by significant diversity in common and professional usage. This report aims to provide definitions that areâinsofar as possibleâ parsimonious, clear, not tautological, consistent with customary professional and legislative usage, and socially and practically acceptable to important interests. The committee recommends that the agency work with the following definitions. PRACTICE GUIDELINES are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. MEDICAL REVIEW CRITERIA are systematically developed statements that can be used to assess the appropriateness of specific health care decisions, services, and outcomes. STANDARDS OF QUALITY are authoritative statements of (1) minimum levels of acceptable performance or results, (2) excellent levels of performance or results, or (3) the range of acceptable performance or results. PERFORMANCE MEASURES (Provisional) 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.