Glossary terms

Click one of the letters above to advance the page to terms beginning with that letter.

A

Advanced Alternative Payment Model

The Advanced Alternative Payment Model (Advanced APM), a subset of Alternative Payment Models, is one of two tracks under CMS’s Quality Payment Program. Eligible clinicians who decide to participate in an Advanced APM, through Medicare Part B, may earn an incentive payment for participating in an innovative payment model. Formerly called the Physician Quality Reporting System (PQRS). For more information, visit https://qpp.cms.gov/.

Adverse Drug Event
Harm to a patient resulting from the use of a medication. (Use potential adverse drug event, or pADE, if harm was likely but did not occur.)
Alternative Payment Model

Alternative Payment Model (APM) is a payment approach that gives added incentive payments to eligible clinicians to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Ambulatory Surgical Center

A place other than a hospital that does outpatient surgery. Ambulatory surgery centers (ASC), also are known as "outpatient surgery centers" or "same day surgery centers".

Antibiotic Stewardship
Programs and practices designed to prevent antibiotic overuse, which can cause dangerous bacteria to become resistant to treatment. The goal of antibiotic stewardship is to ensure that patients get the right drug, in the right dose, for the right amount of time.
Antimicrobial Stewardship
Programs and practices designed to prevent antibiotic overuse, which can cause dangerous bacteria to become resistant to treatment. The goal of antibiotic stewardship is to ensure that patients get the right drug, in the right dose, for the right amount of time.
Antipsychotic Medication

Used to treat a number of psychiatric disorders, including schizophrenia, bipolar mania, dementia, and psychotic depression.

B

Behavioral Health

Health services that include mental and emotional health, psychiatric care, addiction and substance abuse treatment. Services are provided by different kinds of providers, including certified counselors, psychiatrists, psychologists and neurologists.

Beneficiary
A person who has health insurance through the Medicare program. These generally are individuals age 65 and over, but also include those with end-stage renal disease or certain other disabilities.
Beneficiary and Family Centered Care (BFCC)-Quality Improvement Organization
Beneficiary and Family Centered Care (BFCC)-Quality Improvement Organizations manage all beneficiary complaints and quality of care reviews, EMTALA, and other types of case reviews. Two BFCC-QIOs, Livanta and KEPRO, address quality of care concerns and appeals for different U.S. regions.

C

Care Coordination

The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services.

Care settings
Facilities and other channels through which health care is delivered, and with which a specific level of acuity is associated. These range from the most acute: hospitals and other inpatient settings, to the least acute: physician practices and other outpatient settings.
Care transitions
A patient’s move from one care setting to another, such as from a hospital to a nursing home, or from a rehabilitation facility to the patient’s home.
Catheter
A tube that can be inserted into the body and is used to either provide necessary fluids or to allow fluids to drain.
Catheter-associated urinary tract infection (CAUTI)
An infection that happens when bacteria enter the urinary tract through a catheter. CAUTI is a particular type of a health care-acquired infection.
Central line
A tube placed into a large vein in the body, usually in the neck, chest, arm or groin. Central lines may be used to draw blood or give fluids or medications.
Central line-associated bloodstream infection (CLABSI)
An infection that happens when bacteria enter the blood through a central line. CLABSI is a particular type of a health care-acquired infection.
Change agent
An individual or organization with the power and skills to catalyze and support change by others.
Chronic condition
A long-term illness or disease that requires ongoing management by patients and physicians. Examples include diabetes, congestive heart failure and arthritis.
Clinical performance data
Measurements that assist providers in determining how well they are delivering health care; for example, the percentage of a primary care physician’s patients who receive an annual influenza immunization or a surgeon’s infection rate.
Clinical pharmacists
Pharmacists who are part of the patient care team in a hospital, nursing home or outpatient clinic. They consult with clinicians about medication options, dosages, and how drugs are delivered to the patient’s body.
Clostridium difficile (C. diff)
A bacterium that can result from inappropriate use of antibiotics and which can cause severe intestinal distress and debilitation. C. diff is a common, highly contagious health care-acquired infection in both hospitals and nursing homes.
Colorectal screening
Testing to determine whether an individual has cancer of the colon or rectum. The most common test used for colorectal screening is a colonoscopy.
Community coalition
A formal, long-term alliance of organizations, groups, and agencies that come together to work toward a common goal, such as reducing avoidable hospital readmissions.
Community of practice
A group of professionals with a common interest or goal who share knowledge with each other. QIOs convene communities of practice to support health care providers who are striving for improvement in the same clinical area.
Convener
A trusted, unbiased individual or organization that brings together a group of people, especially those that might not otherwise join forces.
Critical Access Hospital

Designation given to certain rural hospitals by the Centers for Medicare & Medicaid Services. These hospitals provide limited outpatient and inpatient hospital services.

D

Disparities

Differences in the delivery of health care, access to health care services and medical outcomes based on ethnicity, geography, gender and other factors.

Dual eligibles

Beneficiaries who are eligible for both Medicare and Medicaid.

E

Electronic Health Records
Medical records that are kept on a computer system, instead of on paper. This allows patients to have better access to their own health information and allows providers to share information necessary to coordinating care.
Eligible clinician

As of 2017 is a physician, physician assistant, nurse practitioner, clinical nurse specialist or certified registered nurse anesthetist who bills more than $30,000 to Medicare and provides care to more than 100 Medicare patients per year.

End Stage Renal Disease

Permanent kidney failure that requires a regular course of dialysis or a kidney transplant.

Evidence-based best practices
Systems or processes for delivering health care that are known to be effective because they have clinical evidence to support them, typically studies in peer-reviewed literature.

F

Federally Qualified Health Center

Community-based, patient-directed organizations that deliver comprehensive, culturally competent, high-quality primary care services in areas where economic, geographic, or cultural barriers limit access to affordable health care services. FQHCs include community health centers, tribal health clinics, migrant health services, and health centers for the homeless.

H

Health care or hospital-acquired condition
An undesirable consequence of receiving health care services that result in harm to the patient, such as a broken hip resulting from a fall in the health care facility.
Health care or hospital-acquired infection
An infection that a patient develops as a result of receiving health care services, such as a urinary tract infection caused by a catheter that was left in place for too long.
Health Information Exchange

The mobilization of healthcare information electronically across organizations within a region, community or hospital system.

Health literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.

Home Health Agency

An organization that provides health care services in the home. Home health care includes, but is not limited to: skilled nursing care, physical therapy, occupational therapy, speech therapy, and care by home health aides.

Hospice

A special way of caring for people who are terminally ill, and for their family. This care includes physical care and counseling.

I

Influenza
The medical term for the flu, an infectious disease caused by a virus.
Inpatient

Health care that you receive when you are admitted to a hospital; someone who is receiving care in a hospital.

Inpatient psychiatric facility

A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician.

Intervention
A process, system or tool that is used to improve health or health care, such as a checklist for the proper insertion of central line catheters to prevent infection.

L

Learning and action network
A group of health care professionals and stakeholder organizations, convened by the QIO, which come together to improve patient care or population health and spread best practices through peer-to-peer learning and solution sharing.
Long term care

Custodial, assistive or supervisory care provided to persons over a period of time. LTC generally takes place in the home, an assistive living facility, or nursing home. Medicare does not pay for this type of care if this is the only kind of care you need.

M

Mammogram
A test to detect cancer that produces an image of the breast using low-energy x-rays.
Mammography

A technique using X-rays to diagnose and locate breast tumors.

Meaningful use

The term used to describe consistent use of the full functionality of an electronic health record to improve patient care and safety.

Meaningful use
As defined for CMS’ electronic health record incentive programs, the term used to describe consistent use of the full functionality of an electronic health record to improve patient care and safety.
Merit-based Incentive Payment System

The Merit-based Incentive Payment System (MIPS) is one of two tracks under CMS’s Quality Payment Program. MIPS allows eligible clinicians to receive a performance-based Medicare payment adjustment based upon how clinicians report evidence-based and practice-specific clinical quality data. To be eligible for the payment, eligible clinicians must demonstrate that they provided high quality, efficient care supported by technology. Formerly called the Physician Quality Reporting System (PQRS). For more information, visit https://qpp.cms.gov/.

Minority health

Addresses the health care needs of different races and ethnic groups.

N

Nursing home

A licensed nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services, and other related health services.

O

Outpatient

Medical or surgical care that does not include an overnight hospital stay. When a person receives medical or surgical care from a clinic or hospital but is not admitted as an inpatient. Outpatient care may include emergency department services, observation services, outpatient surgery, lab tests or X-rays.

P

Patient Safety Clinical Pharmacy Services Collaborative
An improvement initiative originated by the federal Health Resources and Services Agency (HRSA) that focuses on reducing the rates of adverse drug events in high-risk, community-based populations.
Person and family engagement

Actions taken by patients, families and health care providers to help patients participate more fully in their own care. Examples of person and family engagement strategies include shared decision making and patient portals that facilitate access to electronic health records.

Person-centered

Driving rapid, large-scale change that puts patients first.

Plan-Do-Study-Act cycle
A structured trial of a process change. Drawn from the Shewhart cycle, this model includes: Plan - a time to organize the change in anticipation of its execution; Do - a time to try the change and observe what happens; Study - an analysis of the results of the trial; and Act - devising next steps based on the analysis, such as learning from errors in the trial so they are not repeated next time.
Pneumococcal
The medical term for pneumonia-related infections. The pneumococcal vaccine is given to patients in order to prevent pneumonia.
Post-acute care
Medical care that takes place after a patient is discharged from the hospital. Nursing home care and home health care are two examples.
Pressure ulcer
Localized injuries to the skin and/or tissue as a result of pressure from the body’s weight or from an external medical device. Patients with fragile skin who sit or lie for too long in one position are likely to develop pressure ulcers (also known as bedsores).
Preventive care
Methods taken to prevent health conditions before they occur or to prevent health conditions from worsening once they have begun. Examples include getting a flu shot or keeping blood sugar under control in people with diabetes.
Preventive screenings
Tests used to determine a patient’s risk for certain conditions or to identify disease early, when it can be most treatable, often before noticeable symptoms occur. Examples include blood pressure screening to identify people at risk for hypertension.
Prospective Payment System

A method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. The payment amount for a particular service is derived based on the classification system of that service (for example, diagnosis-related groups for inpatient hospital services).

Q

QIN NCC

The Quality Innovation Network National Coordinating Center (QIN NCC) supports a national network of 14 QIN-QIOs as they implement the national quality initiatives of the QIO Program. As the QIN NCC, Telligen provides analytic and technical assistance, spreads promising practices and innovative approaches, and facilitates opportunities for peer-to-peer learning and connection.

Quality Improvement Organization
A group of health quality experts and clinicians organized to improve the care delivered to people with Medicare. QIOs work under the direction of the Centers for Medicare & Medicaid Services to assist Medicare providers with quality improvement and to review quality concerns for the protection of beneficiaries and the Medicare Trust Fund. There is one QIO for each U.S. state, territory and the District of Columbia.
Quality Innovation Network (QIN)-Quality Improvement Organization
Quality Innovation Network (QIN)-Quality Improvement Organizations work with providers, stakeholders and Medicare beneficiaries to improve the quality of health care for targeted health conditions. They are responsible for working with health care providers and the community on data-driven projects to improve patient safety, reduce harm and improve clinical care at the local level.
Quality Payment Program

CMS program to assist eligible clinicians as they transition from volume-based to value-based reimbursement by increasing their capacity to collect and report data, improve clinical quality, use health IT effectively, and manage the total cost of care. For more information, visit https://qpp.cms.gov/.

R

Rapid-cycle improvement
The use of standard quality tools, skilled staff members and multiple iterations of the Plan-Do-Study Act cycle (small tests of change) to improve clinical performance in a limited amount of time.
Readmission
When a patient returns to the hospital shortly after a recent stay, typically within 30 days of discharge.

S

Settings of care
Facilities and other channels through which health care is delivered, and with which a specific level of acuity is associated. These range from the most acute: hospitals and other inpatient settings, to the least acute: physician practices and other outpatient settings.
Skilled Nursing Facility

A licensed nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services, and other related health services.

Stakeholder
Any individual or organization outside of the immediate QIO project team that has a shared interest in achieving the goals of the QIO Program. Stakeholders include other state and federal health agencies, health care providers and community members, Medicare beneficiaries, and national and state associations.

T

Technical assistance
Expert advice, training and hands-on support related to a complex or unfamiliar task. For example, QIOs provide hospitals with technical assistance for reporting data to the National Healthcare Safety Network (NHSN), which includes help obtaining access to the NHSN, training for entering data into the NHSN, and tips for using NHSN-generated reports to benchmark their facility’s performance in preventing infections.