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CONCLUSIONS AND RECOMMENDATIONS 99 settings, practitioner skills and attitudes, levels of resources, perceptions of risks, 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 The committee sought to formulate definitions that, insofar as possible, would be clear, concise, and not tautological; consistent with professional and legislative usage; and practically and symbolically acceptable to important interests. It recommends that the Forum work with the following definitions of the four key terms used in OBRA 89. 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. The committee recognizes that these definitions will not resolve all arguments over what these and related terms mean, but it believes these four statements will bring a degree of badly needed clarity and uniformity to the field. Moreover, these definitions can be used by the Forum and, indeed, have already been incorporated into its work. One underlying premise highlighted by these definitions is that these four terms are not synonymous. Assistance to physicians and patients in making decisions is not the same as tools for evaluating practice. Therefore, although the definitions may evolve, it is important to underscore that these are not equivalent concepts or phrases and should not be used interchangeably. Not part of the committee's definition of practice guidelines but central to its view of the field is the precept that every guideline should be accompanied by a statement of the strength of the evidence and the expert judgment behind it. The committee has not tried to distinguish types or