Glossary

Filter by quality entity

  • Adherence


    A patient's ability to follow a treatment protocol or take prescribed medication according to directions, including required dosage and frequency.1

  • Case management


    The monitoring and coordination of medical care to meet a patient's needs over time, particularly for specific diagnoses that may require high-cost or extensive services.1

  • CDS—clinical decision support


    A computerized tool or application providing key person-specific data and evidence-based best practices to physicians and other clinicians in response to triggers or "flags" embedded in the system.1

  • Chronic care


    Ongoing care for an illness over a period of time or recurring frequently.2

  • Clinical practice guidelines or management


    A quality-management protocol designed to assist providers in clinical decision-making for the treatment of a specific clinical case.1

  • CMS—Centers for Medicare & Medicaid Services


    A federal agency within the US Department of Health and Human Services (HHS) responsible for Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP).1

  • Continuum of care


    When a system guides and tracks patients over time through comprehensive health services spanning all levels and intensity of care. The continuum of care may also refer to the delivery of health care provided from birth to end of life.3

  • Direct costs


    Costs assigned to procedure-specific services, such as physician and support personnel (labor), equipment, and supplies.1

  • Discharge planning


    Evaluation of an inpatient medical condition to determine continuing care needs upon discharge from the facility.2

  • Disease management


    Using a system of coordinated health care interventions and communication, known as integrated care, to improve quality of life for patients with chronic conditions and reduce associated costs from avoidable complications.1

  • DPIs—dry-powder inhalers


    Inhalers that are small and portable; moderate-to-high inspiratory flow delivers drug.4

  • DRGs—diagnosis-related groups


    A system used to categorize medical cases and reimburse hospitals and other health care providers based on patient diagnosis. This system is used as the basis for Medicare's hospital reimbursement program.1

  • EHR—electronic health record


    An electronic record-keeping system designed to contain and share patient medical information and history between all providers involved in that patient's medical care. See also EMR—electronic medical record.5

  • EMR—electronic medical record


    An electronic version of a patient health record generated by one or more encounters in a particular care setting and maintained over time, usually by a single provider. See also EHR—electronic health record.5

  • Formulary management


    An integrated patient care strategy used by managed health care systems to support effective clinical and therapeutic outcomes in an affordable and cost-effective way.1

  • HCUP—Healthcare Cost and Utilization Project


    A family of health care databases and related digital information resource tools developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ) to collect and share longitudinal hospital data care in the United States. Enables research into a variety of health policy issues at the national, state, and local levels.6

  • Health Information Exchange


    The electronic transfer of health-related information between organizations according to nationally recognized standards.7

  • Health literacy


    The degree to which individuals have the ability to obtain and understand basic health information and services to make meaningful health decisions.8

  • HEDIS—Healthcare Effectiveness Data and Information Set


    A set of measures widely used in the managed care industry to compare the clinical quality and performance among health plans. These measures cover many aspects of health care and are revised each year.9

  • HIT—Health information technology


    A broad concept that includes a variety of technologies to store, share, and analyze health information.5

  • HRRP—Hospital Readmissions Reduction Program


    Medicare program established in the Affordable Care Act (ACA) that provides a financial incentive to hospitals to lower readmission rates for Medicare patients.10

  • ICD-10-CM—International Classification of Diseases, 10th Revision, Clinical Modification


    A classification system that lists a set of codes for each possible medical diagnosis. Used by physicians to accurately describe and document diagnoses, and by insurance providers and Medicare to determine reimbursement. The codes are revised periodically by the UN World Health Organization.11

  • IDS—Integrated (Health Care) Delivery Systems


    A term used to describe organizations or networks that offer a continuum of care, from primary care providers to specialists and other clinicians, under one corporate entity. Managed Care Organizations (MCOs) are a primary example of an IDS.1

  • MACRA—The Medicare Access and CHIP Reauthorization Act of 2015


    MACRA replaced Medicare’s established ways to pay clinicians for caring for Medicare beneficiaries.12

    MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS.”12

  • MDIs—metered-dose inhalers


    Small and portable inhalers, with a short administration time and no drug preparation, that require coordination of breathing and device actuation.4,13,14

  • Medicare


    A federal health insurance program for people over 65 and other specific younger groups with chronic conditions or disabilities. Operated by the Centers for Medicare and Medicaid Services (CMS).1

  • Medicare Advantage


    Medicare Advantage plans (previously called Medicare+Choice) are offered by private companies approved by Medicare to provide medical benefits in lieu of original Medicare. These companies include Health Maintenance Organizations (HMOs) and other competitive medical plans.1

  • NCQA—National Committee for Quality Assurance


    An independent, not-for-profit organization founded in 1990 in the United States that works to improve the quality of health care through the development and application of evidence-based standards, measurement, and accreditation.1

  • Nebulizer


    Delivers medication through regular breathing; requires multiple steps for device setup and cleaning, and has an administration time of up to 20 minutes.4,15

  • Performance measures


    Systematic measurements of patient outcomes used to assess provider performance in relation to a set of quality standards.1

  • PHM—Population health management


    A framework within the health care industry for studying and facilitating care delivery across settings for the general population or a specific group of individuals with the aim of improving patient’s health and provider’s financial outcomes.16

  • Quality measures


    Tools that assist in measuring health care processes, outcomes, patient perceptions, and systems within an organization that are associated with the ability to provide high-quality health care and relate to specific quality goals for health care, including care that is effective, safe, efficient, patient centered, and timely.17

  • Slow-mist inhalers


    Inhalers that are small and portable; require specific breathing techniques and multiple steps for setup.13,15

  • Telemedicine/telehealth


    The use of telecommunication and information technology to provide clinical health care from a distance. Telemedicine is increasingly employed in remote or rural areas to provide services including but not limited to oncology, home health, ER diagnosis, radiology, and psychology.1

  • Transition of care


    Measures employed by many benefit plans to oversee the use of appropriate, high-quality medical services that are delivered in a cost-effective manner.18


 

References:

  1. Academy of Managed Care Pharmacy. Managed care terms. http://www.amcp.org/ManagedCareTerms/. Accessed January 22, 2018. 
  2. National Association of Health Underwriters. Glossary. https://nahu.org/looking-for-an-agent/glossary. Accessed March 19, 2018.
  3. Healthcare Information and Management Systems Society. Definition: continuum of care. http://www.himss.org/definition-continuum-care. Accessed March 19, 2018.
  4. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest. 2005;127(1):335-371. 
  5. Department of Health and Human Services. Office of the National Coordinator for Health Information Technology. HealthIT Buzz. https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference/. Accessed March 23, 2018.
  6. Healthcare Cost and Utilization Project. Overview of HCUP. https://hcup-us.ahrq.gov/overview.jsp. Accessed March 19, 2018.
  7. National Alliance for Health Information Technology. Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. http://www.himss.org/national-alliance-health-information-technology-report-office-national-coordinator-health. April 28, 2008. 
  8. US Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Health literacy basics. Health Communication Activities. https://health.gov/communication/literacy/quickguide/factsbasic.htm. Accessed March 19, 2018.
  9. National Committee for Quality Assurance. What is HEDIS? http://www.ncqa.org/hedis-quality-measurement/what-is-hedis. Accessed March 19, 2018. 
  10. Centers for Medicare & Medicaid Services. Readmissions Reduction Program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Accessed March 19, 2018.
  11. World Health Organization. ICD education. http://www.who.int/classifications/icd/en/. Accessed March 19, 2018.
  12. Centers for Medicare & Medicaid Services. The Medicare Access and CHIP Reauthorization Act of 2015: Path to value. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf. Accessed March 19, 2018.
  13. Tashkin DP. A review of nebulized drug delivery in COPD. Int J Chron Obstruct Pulmon Dis. 2016;11:2585-2596. 
  14. Restrepo RD, Alvarez MT, Wittnebel LD, et al. Medication adherence issues in patients treated for COPD. Int J Chron Obstruct Pulmon Dis. 2008;3(3):371-384.
  15. Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58-72. 
  16. SearchHealthIT. Definition: population health management (PHM). http://searchhealthit.techtarget.com/definition/Population-health-management-PHM. Accessed March 19, 2018.
  17. Centers for Medicare & Medicaid Services. Quality measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html. Accessed March 19, 2018.
  18. Centers for Medicare & Medicaid Services. Eligible professional meaningful use menu set measures: measure 7 of 9. Updated May 2014. https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/8_Transition_of_Care_Summary.pdf. Accessed March 19, 2018.