Glossary of Terms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

Academic Medical Center (AMC)

A group of related institutions, including a teaching hospital or hospitals, a medical school and its affiliated faculty practice plan, and other health professional schools.

Accreditation

A formal process by which a recognized body, usually a non-governmental institution, assesses and recognizes that a healthcare organization meets applicable, pre-determined standards.

ACE Inhibitor

An ACE (angiotensin converting enzyme) inhibitor is a type of medicine used to treat heart attacks, heart failure, or a decreased function of the left side of your heart. ACE inhibitors can help reduce the risk of death from a heart attack if taken within 24 hours of the first symptoms of a heart attack. Continued use may help prevent heart failure. ACE inhibitors work by stopping the production of a hormone that narrows blood vessels. This helps reduce the pressure in your heart and lower blood pressure. If you have a heart attack, you should get a prescription for ACE inhibitors before you leave the hospital.

Acute Myocardial Infarction (AMI)

Commonly referred to as a heart attack. Occurs when arteries leading to the heart become blocked and stop blood flow to the heart. The affected part of the heart does not get oxygen and other nutrients. Without immediate treatment, the affected area dies or is permanently damaged.

Adverse Drug Event (ADE)

An adverse event involving medication use.

Adverse Outcome

An injury due to a medical treatment.

AHRQ

Agency for Healthcare Research & Quality [formerly Agency for Health Care Policy & Research (AHCPR)].

AMA

American Medical Association.

Ambulatory Care

Medical services provided on an outpatient (non-hospitalized) basis. Services may include diagnosis, treatment, surgery, and rehabilitation.

Aspirin

Acetylsalicylic acid; a medicine commonly used to relieve pain and reduce inflammation; used at the first signs of heart attack to prevent blood clots.

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B

Benchmarking

A process of searching out and studying the best practices that produce superior performance. Benchmarks may be established within the same organization (internal benchmarking), outside of the organization with another organization that produces the same service or product (external benchmarking), or with reference to a similar function or process in another industry (functional benchmarking).

Best Practices

The most up-to-date patient care interventions, scientifically proven to result in the best patient outcomes and minimize patients’ risk of death or complications.

Beta Blockers

Medicine used to lower blood pressure, treat chest pain and heart failure, and help prevent a heart attack. Beta blockers relieve the stress on the heart by slowing the heart rate and reducing the force with which the heart muscles contract to pump blood.

Board Certified

Status granted to a medical specialist who completes required training and passes and examination in his/her specialized area. Individuals who have met all requirements, but have not completed the exam are referred to as "board eligible."

Board Eligible

Reference to medical specialists who have completed all required training but have not completed the exam in his/her specialized area.

Broad Specialty Care

Specialized healthcare provided by physicians whose training is primarily focused on a specific field, such as neurology, cardiology, rheumatology, dermatology, oncology, orthopaedics, ophthalmology, and other specialized fields.

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C

CAHPS

Consumer Assessment of Health Plans.

Case Management

A collaborative process that assesses, plans, implements, evaluates, and coordinates options and services to ensure cost-effective case based on the needs of particular clients.

Centers for Medicare and Medicaid Services (CMS)

The federal agency that runs the Medicare program for the elderly and disabled individuals. In addition, CMS works with the states to run the Medicaid program for low-income individuals.

Centers of Excellence

Healthcare facilities specially equipped for and specializing in difficult, complex, and expensive tertiary care procedures, such as kidney or other organ transplants, cataract surgery, or coronary artery bypass surgery.

Certification

A process by which an authorized body, either a governmental or non-governmental organization, evaluates and recognizes either an individual or an organization as meeting pre-determined requirements or criteria.

Clinical Measures

Measures representing processes of care and patient outcomes widely accepted as important to quality care, consistently and accurately tracked in order to determine quality performance in a given clinical area, such as heart attack, pneumonia, or hip and knee replacement.

Clinical Pathway

A patient care management tool that organizes, sequences, and times the major interventions of nursing staff, physicians, and other departments for a particular case type.

Clinical Performance

The degree of accomplishment of desired health objectives by a clinician or healthcare organization.

Clinical Performance Measure

A subtype of quality measure that is a mechanism for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in the optimal time period.

Clinical Practice Guidelines

A set of systematically developed statements, usually based on scientific evidence, to assist practitioners and patient decision making about appropriate healthcare for specific clinical circumstances.

Close Call

Also referred to as a “near miss,” an event or situation that could have, but did not produce patient injury; however, only because of chance.

CMS

See Centers for Medicare and Medicaid Services.

Complication Rate

Incidence of medical problems associated with a particular procedure or illness.

Computerized Physician Order Entry or Computerized Provider Order Entry (CPOE)

A computer-based system used for ordering medications and tests. Some CPOEs have enhanced capabilities for providing physicians with care protocols and other information.

Coordination of Care

The mechanisms ensuring that the patient and clinicians have access to, and take into consideration, all required information on the patient's conditions and treatments to ensure that the patient receives appropriate healthcare services.

Congestive Heart Failure (CHF)

Congestive heart failure, or heart failure, is a condition in which the heart can't pump enough blood to the body's other organs. The "failing" heart keeps working but not as efficiently as it should.

Consumer Assessment of Health Plans (CAHPS)

CAHPS surveys probe those aspects of care for which consumers and patients are the best and/or only source of information, as well as those that consumers and patients have identified as being important.

Continuous Quality Improvement (CQI)

A management approach to improving and maintaining quality that emphasizes internally driven and relatively continuous assessments of potential causes of quality defects, followed by action aimed either at avoiding decrease in quality or else correcting it an early stage.

Core Measures

Specific clinical measures that, when viewed together, permit a robust assessment of the quality of care provided in a given focus area, such as acute myocardial infarction (AMI).

Credentialing

The process by which a hospital or other healthcare facility grants permission to health professionals to practice in the facility. The process consists of a thorough investigation into the background of each individual including such things as education, licenses, prior practice, and prior disciplinary sanctions.

Criteria

Expected levels of achievement or specifications against which performance or quality may be compared. For example, criteria for appropriate initial care of a patient with a headache may be a measurement of body temperature and blood pressure and performance of a neurological examination.

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D

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E

Economic Incentives

Initiatives to reward and motivate healthcare providers who provide effective and efficient care using specific performance measures. Incentives may be provided by healthcare purchasers, health plans, and others.

Effectiveness

The degree to which care is provided in the correct manner, given the current state of knowledge, to achieve the desired or projected outcome(s) for the patient.

Evidence-based Hospital Referral

Ensuring patients with high-risk conditions are treated at hospitals with characteristics shown to be associated with better outcomes. Those characteristics include a combination of outcome, process, and volume criteria.

Evidence-based Medicine

The wise and careful use of the best available scientific research and practices with proven effectiveness in daily medical decision making, including individual clinical practice decisions, by well-trained, experienced clinicians. Evidence-based medicine that is best-practice integrates best research evidence with clinical expertise and patient values. The Centers for Medicare and Medicaid Services (CMS) and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have developed common performance measures for the most common and costly health conditions. The measures allow consumers to compare medical providers to learn which ones routinely offer the most effective care.

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F

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G

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H

Health Outcomes

The effect on health status from performance (or non-performance) of one or more processes or activities carried out by healthcare providers. Health outcomes include morbidity and mortality; physical, social, and mental functioning; nutritional status; etc.

Health Plan

An organization that offers reimbursement for its members' healthcare services. It can be a health maintenance organization (HMO), a preferred provider organization (PPO), a commercial insurance carrier, or a company that self-insures.

Health Plan Employer Data and Information Set (HEDIS)

A set of core performance measures designed by participating managed health plans and employers to respond to employers’ needs to understand the value of their healthcare and to hold plans accountable for performance. HEDIS is sponsored by the National Committee for Quality Assurance (NCQA).

Heart Attack

Also known as acute myocardial infarction (AMI). Occurs when arteries leading to the heart become blocked and stop blood flow to the heart. The affected part of the heart does not get oxygen and other nutrients. Without immediate treatment, the affected area dies or is permanently damaged.

HIPAA

Health Insurance Portability and Accountability Act.

Hospital Quality Alliance (HQA)

A public-private collaboration between several national healthcare government and non-profit organizations. It was established to promote reporting on hospital quality of care and to share hospital quality information with patients, families, and communities is a unified, consistent manner. The HQA currently gathers and reports information on three common and serious medical conditions – heart attack, heart failure, and pneumonia – on a website called Hospital Compare.

Hypoxemia

Inadequate oxygen supply in the arterial blood. It is common in patients with pneumonia and is treated by giving supplemental oxygen.

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I

Incident Reporting

Refers to the identification of occurrences that could have led, or did lead, to an undesirable outcome. Reports usually come from personnel directly involved in the incident or events leading up to it (e.g., the nurse, pharmacist, or physician caring for a patient when a medication error occurred).

Indicator

A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or the level of quality achieved.

Inpatient

A person who has been admitted to a hospital or other health facility for a period of at least 24 hours.

Institute for Healthcare Improvement (IHI)

A not-for-profit organization driving the improvement of health by advancing the quality and value of healthcare. The Institute helps accelerate change in healthcare by cultivating promising concepts for improving patient care and turning those ideas into action.

Institute of Medicine (IOM)

An organization within the National Academy of Sciences that acts as an advisor in health and medicine and conducts policy studies relevant to health issues. The IOM was chartered in 1970 by National Academy of Science to enlist distinguished members of appropriate professions in the examination of policy matters pertaining to the health of the public. The IOM is an advisor to federal government on issues of medical care, research, and education.

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J

The Joint Commission

An organization that evaluates and accredits healthcare organizations and programs in the United States. The Joint Commission is an independent, not-for-profit organization. A hospital is accredited by the Joint Commission if it meets certain quality standards. These checks are done at least every 3 years. Most hospitals take part in these accreditations.

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K

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L

Leapfrog Group

More than 160 organizations that buy healthcare who are working to initiate breakthrough improvements in the safety, quality, and affordability of healthcare for Americans.

Left Ventricular Function (LVF)

A measure of how efficiently the heart is pumping.

Licensure

A process by which a governmental authority grants permission to an individual practitioner or healthcare organization to operate or to engage in an occupation or profession.

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M

Magnet Hospital Status

Refers to a designation by the Magnet Hospital Recognition Program administered by the American Nurses Credentialing Center.

Measure

A mechanism to assign a quantity to an attribute by comparison to a criterion.

Measurement

The process of collecting data to assess performance conducted at a single point in time or repeated over time.

Medication Reconciliation

A formal process of obtaining a complete and accurate list of each patient's current home medications – including name, dosage, frequency, and route – and comparing the physician's admission, transfer, and/or discharge orders to that list. Discrepancies are brought to the attention of the prescriber and, if appropriate, changes are made to the orders. Any resulting changes in orders are documented.

Morbidity

The state of being diseased; ratio of persons who are diseased to those who are well in a given community.

Mortality

The number of deaths occurring per the number of units in the population at risk for the occurrence (e.g., per 100,000 population); death rate.

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N

National Patient Safety Goals (NPSG)

Annual goals established by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to encourage improved patient safety in hospitals and other healthcare settings.

National Quality Forum (NQF)

A private, not-for-profit membership organization created to develop and implement a national strategy for healthcare quality measurement and reporting. The mission of the NQF is to improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and, efficient.

Nosocomial Infection

An infection acquired during hospitalization.

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O

ORYX/Performance Measurement

A system initiated by the JCAHO to integrate outcomes and other performance measurement data into the accreditation process.

Outcome

Result of a process, including outputs, effects, and impacts.

Outcome Measure

A measure that indicates the result of the performance (or non-performance) of a function or process.

Oxygenation Assessment

A test to measure the amount of oxygen in the blood. The assessment may include an arterial blood gas (ABG) or pulse oximetry. Pneumonia patients may experience poor blood oxygenation when air spaces in the lungs fill with fluid.

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P

Patient Safety

Freedom from accidental or preventable injuries produced by medical care.

Patient Satisfaction

A measurement that obtains reports or ratings from patients about services received from an organization, hospital, physician, or healthcare provider.

Patient Values

The unique preferences, concerns, and expectations that each patient brings to a clinical encounter that must be integrated into clinical decisions if they are to serve the patient.

Patient-centered Care

Care that is respectful of and responsive to individual patient preferences, needs, and values and ensures patient values guide all clinical decisions; care that is coordinated, communicative, and supportive.

Pay for Performance

A direct financial reward model or quality bonus; incentive and reward models where there are direct provider dollars at stake for quality improvement.

Percutaneous Coronary Intervention (PCI)

A procedure, such as angioplasty, that opens a blocked blood vessel.

Performance Measure

Provides an indication (e.g., rate, ratio, index, percentage) of an organization's/or provider's ability to provide care most likely to ensure a good patient outcome.

Pneumococcal Vaccination

An immunization against Streptococcus pneumoniae, a bacterium that frequently causes meningitis and pneumonia in the elderly and people with chronic illnesses.

Pneumonia

Inflammation of the lungs caused by an infection. Can be caused by a variety of organisms, including bacteria, viruses, and fungi.

Primary Care

Basic or general healthcare traditionally provided by doctors trained in: family practice, pediatrics, internal medicine, and occasionally gynecology.

Procedure

Step-by-step instructions on how to perform a task based on technical and theoretical knowledge.

Process Measure

A series of actions, functions, or changes, which lead to a certain anticipated outcome. A scientific basis exists for believing that the process, when executed well, will increase the probability of achieving a desired outcome.

Process of Care

A healthcare service provided to, on behalf of, or by a patient appropriately based on scientific evidence of efficacy or effectiveness.

Protocol

A detailed plan, or set of steps, to be followed in a study, an investigation, or an intervention, as in the management of a specific clinical condition.

Pulse Oximetry

A test used to assess blood oxygen levels. It may be measured with an electrode attached to a finger, earlobe, or skinfold. The test is painless.

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Q

Quality

Quality healthcare is how well a doctor, hospital, health plan, or other provider of healthcare keeps its members healthy or treats them when they are sick. Good quality healthcare means doing the right thing at the right time, in the right way, for the right person and getting the best possible results.

Quality Assessment

Determination of how processes and services correspond to current standards, as well as a patient's satisfaction with the care received.

Quality Assurance

That set of activities that are carried out to set standards and to monitor and improve performance so the care provided will satisfy stated or implied needs.

Quality Improvement

An approach to the study and improvement of the processes of providing healthcare services to meet needs of clients.

Quality Improvement Organization (QIO)

Private quality improvement contractors who work with Medicaid in all 50 states. QIOs who work collaboratively with healthcare practitioners, health plans, and hospitals to analyze healthcare patterns, identify opportunities for improvement, and interpret and share information about current science and best practices.

Quality Indicator

An agreed-upon process or outcome measure that is used to determine the level of quality achieved. A measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or achievement of quality goals.

Quality Management

An ongoing effort to provide services that meet or exceed customer expectations through a structured, systematic process for creating organizational participation in planning and implementing quality improvements.

Quality Measure

A quality measure, also referred to as a quality indicator, is a formula that converts medical information from patient records into a rate, or percentage, that shows how well a hospital cares for its patients. Quality measures can help consumers rate the performance of hospitals, health professionals, and physicians. They include:

• Clinical process measures – what was done to get to an end result (such as giving antibiotics prior to and after certain surgical procedures)
• Clinical outcomes – what was the end result for the patient (like infection rates, mortality, and length of stay in the hospital)
• Procedure volumes – how often a procedure is done at a heath care facility or by an individual physician
• Structure – how care is organized (such as whether a health care facility uses computerized physician order entry [CPOE] rather than handwritten medication orders) as well as types and availability of services

Quality Monitoring

The collection and analysis of data for selected indicators that enable managers to determine whether key standards are being achieved as planned and are having the expected effect on the target population.

Quality of Care

The degree to which healthcare services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

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R

Rapid Response Team

A group of clinicians who can rapidly bring assessment and management skills to the bedside of a patient whose condition may be deteriorating, and before he or she becomes unstable and requires emergency transfer to the intensive care unit or cardiopulmonary resuscitation. Rapid response intervention can be activated by any member of the patient’s healthcare team in response to a defined set of physiologic abnormalities or at the request of a healthcare provider who believes the patient is approaching instability.

Risk-adjustment

A tool to account for patient-related variation (age, sex, additional diseases) when comparing different populations of patients (e.g., physician group A and physician group B).

Root Cause Analysis (RCA)

A structured process for identifying the cause or contributing factors of adverse events or other critical incidents.

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S

Safe Practices

Practices that reduce the risk of harm from the processes, practices, or systems of healthcare, the standardization of which is likely to have significant benefit for patient safety if fully implemented.

Safety

The avoidance of injuries to patients from the care that is intended to help them.

Safety Culture

Also known as culture of safety, these terms refer to a commitment to safety that permeates all levels of an organization, from frontline personnel to top management.

Satisfaction Measures

Measures that address the extent to which the patients/enrollees, practitioners, and/or purchasers perceive their needs to be met.

Sentinel Event

An adverse event in which death or serious harm to a patient has occurred; usually refers to unexpected or unacceptable events, such as operation on the wrong patient or body part.

Six Sigma

A methodology that provides organizations with the tools to improve the capability of their business processes. This increase in performance and decrease in process variation lead to defect reduction and improvement in profits, employee morale and quality of product.

Standard of Care

A generally accepted, objective standard of measurement such as a performance standard supported through findings from expert consensus, based on specific research and/or documentation in scientific literature, against which an individual's or organization's level of performance may be compared.

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T

Tertiary Care

Specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment. (Secondary medical care is the medical care provided by a physician who acts as a consultant at the request of the primary physician.)

Time-outs

Planned periods of quiet and/or interdisciplinary discussion focused on ensuring that key procedural details have been addressed. For instance, protocols for ensuring correct-site surgery often recommend a "time-out" to confirm the patient’s identity, the nature and site of the surgical procedure, and other key details.

Timeliness

The ability to provide the appropriate care when it is needed.

Total Quality Management (TQM)

An approach to quality assurance that emphasizes a thorough understanding by all members of a production unit of the needs and desires of the ultimate service recipients, a viewpoint of wishing to provide service to internal, intermediate service recipients in the chain of service, and a knowledge of how to use specific data-related techniques to assess.

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U

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V

Validation

After collecting quality data, validation is used to confirm the accuracy of the results. The validation process involves a secondary review of a sample of patient records.

Variation

A measure of the change in data, a variable, or a function.

Volume-based Referrals

The number of procedures of a given type a hospital performs each year. Studies demonstrate better results tend to occur at high-volume hospitals for certain high-risk procedures, such as cardiovascular procedures and major cancer resections. It is believed that lower surgical mortality at high-volume hospitals reflects more proficiency with all aspects of care.

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W

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X

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Y

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Z

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