Accountable Care Organization (ACO)—An accountable care organization is a group of health care providers (e.g. primary care physicians, specialists and hospitals) that have entered into a formal arrangement to assume collective responsibility for the cost and quality of care of a specific group of patients and that receive financial incentives to improve the quality and efficiency of health care.
Acute care—Acute care is short-term medical treatment, most often in a hospital, for people who have a severe illness or injury, or are recovering from surgery.
Admission or hospital admissions—Admission or hospital admissions is the process of being admitted to a hospital as a patient. The rate and quality of this process may be a good indicator of the local health system’s performance and the effectiveness of health plans in managing care.
Agency for Healthcare Research and Quality (AHRQ)—The Agency for Healthcare Research and Quality (AHRQ) is the nation’s lead federal agency for research on health care quality, costs, outcomes and patient safety. AHRQ is the health services research arm of the U.S. Department of Health and Human Services (HHS), complementing the biomedical research mission of its sister agency, the National Institutes of Health. The agency is home to research centers that specialize in major areas of health care research, including: clinical practice and technology assessment, health care organization and delivery systems, and primary care. AHRQ is a major source of funding and technical assistance for health services research and research training at leading U.S. universities and other institutions. As a science partner, the agency works with the public and private sectors to build the knowledge base for what works—and does not work—in health and health care and to translate this knowledge into everyday practice and policy-making.
Alliance for Specialty Medicine (ASM)—The Alliance for Specialty Medicine (ASM) is a nonpartisan coalition of 11 national medical specialty societies representing more than 200,000 physicians. ASM is dedicated to the development of sound federal health care policy that fosters patient access to the highest quality specialty care.
Ambulatory Care Quality Alliance (AQA)—The Ambulatory Care Quality Alliance (AQA) is a broad-based coalition of physicians, consumers, purchasers, health insurance plans and others who seek to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring performance at the physician or group level; collecting and aggregating data in the least burdensome way; and reporting meaningful information to consumers, physicians and other stakeholders to inform choices and improve outcomes.
Ambulatory care—Ambulatory care is medical care provided on an outpatient basis—therefore, not requiring a person to be admitted to the hospital. Ambulatory Care is provided in physicians’ offices, clinics, emergency departments, outpatient surgery centers and hospital settings that do not involve a patient staying overnight.
America’s Health Insurance Plans (AHIP)—America’s Health Insurance Plans (AHIP) is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans. Member companies offer medical-expense insurance, long-term care insurance, disability-income insurance, dental insurance, supplemental insurance, stop-loss insurance and reinsurance to consumers, employers and public purchasers. AHIP’s goal is to provide a unified voice for the health care financing industry; to expand access to high-quality, cost-effective health care to all Americans; and to ensure Americans’ financial security through robust insurance markets, product flexibility and innovation, and an abundance of consumer choice.
American Academy of Family Physicians (AAFP)—The American Academy of Family Physicians (AAFP) is one of the largest national medical organizations, representing more than 94,000 family physicians, family medicine residents and medical students nationwide. Founded in 1947, its mission is to preserve and promote the science and art of family medicine and to ensure high-quality, cost-effective health care for patients of all ages.
American Health Quality Association (AHQA)—The American Health Quality Association (AHQA) is an educational, nonprofit national membership association dedicated to promoting and facilitating fundamental change that improves the quality of health care in America. AHQA represents Quality Improvement Organizations (QIOs) and professionals, sharing information about best practices with physicians, hospitals and nursing homes. Working together with health care providers, QIOs identify opportunities and provide assistance for improvement.
American Hospital Association (AHA)—The American Hospital Association (AHA) is a national organization, founded in 1898, that represents and serves all types of hospitals, health care networks, and their patients and communities. The AHA provides education for health care leaders and is a source of information on health care issues and trends. Through representation and advocacy activities, the AHA ensures that members’ perspectives and needs are heard and addressed in national health policy development, legislative and regulatory debates, and judicial matters. Our advocacy efforts include the legislative and executive branches and include the legislative and regulatory arenas. Nearly 5,000 hospitals, health care systems, networks, other providers of care and 37,000 individual members come together to form the AHA.
American Medical Association (AMA)—The American Medical Association (AMA) helps doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues. The AMA seeks to promote the art and science of medicine and the betterment of public health.
American Nurses Association (ANA)—The American Nurses Association (ANA) is the only full-service professional organization representing the nation’s 2.9-million registered nurses (RNs) through its 54-constituent member associations. The ANA advances the nursing profession by fostering high standards of nursing practice, promoting the rights of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.
Benchmark (benchmarking)—Benchmarking is a way for hospitals and doctors to analyze quality data, both internally and against data from other hospitals and doctors, to identify best practices of care and improve quality
Best practices—Best practices are the most up-to-date patient care interventions, which result in the best patient outcomes and minimize patient risk of death or complications.
Center for Health Care Strategies (CHCS)—The Center for Health Care Strategies (CHCS) is a nonprofit health policy resource center dedicated to improving the quality and cost effectiveness of health care services for low-income populations and people with chronic illnesses and disabilities. CHCS works directly with states and federal agencies, health plans, and providers to develop innovative programs that better serve people with complex and high-cost health care needs.
Center for Health Improvement (CHI)—The Center for Health Improvement (CHI) is a national, independent, nonprofit health policy and technical assistance organization dedicated to improving population health and encouraging healthy behaviors. Since its inception in 1995, CHI has used evidence-based research to help public, private and nonprofit organizations strengthen their capacity to improve the quality and value of health care and enhance public health at the community level.
Center for Studying Health Systems Change (HSC)—The Center for Studying Health Systems Change (HSC) is a nonpartisan policy research organization located in Washington, D.C. HSC designs and conducts studies focused on the U.S. health care system to inform the thinking and decisions of policy-makers in government and private industry. In addition to this applied use, HSC studies contribute more broadly to the body of health care policy research that enables decision-makers to understand change and the national and local market forces driving that change.
Centers for Medicare & Medicaid Services (CMS) (formerly: Health Care Financing Administration: HCFA)—The Centers for Medicare & Medicaid Services (CMS) seeks to ensure effective, up-to-date health care coverage and to promote quality care for beneficiaries. Ultimately, CMS is working to transform and modernize the health care system.
Chronic care model—The chronic care model is a model developed by Edward Wagner and colleagues that provides a solid foundation from which health care teams can operate. The model has six dimensions: community resources and policies; health system organization of health care; patient self-management supports; delivery system redesign; decision support; and clinical information system. The ultimate goal is to have activated patients interact in a productive way with well-prepared health care teams. Three components that are particularly critical to this goal are adequate decision support, which includes systems that encourage providers to use evidence-based protocols; delivery system redesign, such as using group visits and same-day appointments; and use of clinical information systems, such as disease registries, which allow providers to exchange information and follow patients over time.
Chronic disease—A chronic disease is a sickness that is long-lasting or recurrent. Examples include diabetes, asthma, heart disease, kidney disease and chronic lung disease.
Clinical practice guidelines—Clinical practice guidelines aare a set of systematically developed statements, usually based on scientific evidence, that help physicians and their patients make decisions about appropriate health care for specific medical conditions. Clinical practice guidelines briefly identify and evaluate the most current information about prevention, diagnosis, prognosis, therapy, risk/benefit and cost effectiveness.
Comparative effectiveness research—Comparative effectiveness research compares multiple medications or treatments to determine which is most effective for different types of patients.
Consumer—A consumer is an individual who uses, is affected by, or is entitled or compelled to use a health-related service.
Consumer Assessment of Healthcare Providers and Systems (CAHPS)—The Consumer Assessment of Healthcare Providers and Systems (CAHPS) develops and supports the use of a comprehensive and evolving family of standardized surveys that ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers, such as the communication skills of providers and the accessibility of services. CAHPS originally stood for the Consumer Assessment of Health Plans Study, but as the products have evolved beyond health plans, the name has evolved as well to capture the full range of survey products and tools.
Consumer engagement—Consumer engagement is the situation in which consumers take an active role in their own health care, from understanding their own conditions and available treatments, to seeking out and making decisions based on information about the performance of health care providers.
Consumer-Purchaser Disclosure Project (CPDP)—The Consumer-Purchaser Disclosure Project (CPDP) is a group of leading employer, consumer and labor organizations working toward a common goal to ensure that all Americans have access to publicly-reported health care performance information. CPDP’s shared vision is that with this information, Americans will be better able to select hospitals, physicians and treatments based on nationally standardized measures for clinical quality, consumer experience, equity and efficiency.
Consumer-driven (or directed) care—Consumer-driven (or directed) care is a form of health insurance that combines a high-deductible health plan with a tax-favored Health Savings Account, Flexible Spending Account or Health Reimbursement Account to cover out-of-pocket expenses. These accounts are “consumer-driven” in that they give participants greater control over their own health care, allowing individuals to determine on a personal basis how they choose to spend their health care account funds.
Coordination of care—Coordination of care comprises mechanisms that ensure patients and clinicians have access to, and take into consideration, all required information on a patient’s conditions and treatments to ensure that the patient receives appropriate health care services.
Core measures—Core measures are 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).
Data collection—Data collection is the acquisition of health care information or facts based upon patient and consumer race, ethnicity and language. Data Collection provides health care providers with the ability to perform benchmarking measures on health care systems to determine areas where improvement is needed in providing care.
Department of Health and Human Services (HHS)—The Department of Health and Human Services is the U.S. government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.
Disease management—Disease management is an approach designed to improve the health and quality of life for people with chronic illnesses by working to keep the conditions under control and prevent them from getting worse.
Disease registry—A Disease registry is a large collection or registry belonging to a health care system that contains information on different chronic health problems affecting patients within the system. A disease registry helps to manage and log data on chronic illnesses and diseases. All data contained within the disease registry are logged by health care providers and are available to providers to perform benchmarking measures on health care systems.
Disparities (in care)—Disparities in care are differences in the delivery of health care, access to health care services and medical outcomes based on ethnicity, geography, gender and other factors that do not include socioeconomic status or insurance coverage. Understanding and eliminating the causes of health care disparities is an ongoing effort of many groups and organizations.
Effective care—Effective care includes health care services that are of proven value and have no significant tradeoffs. The benefits of the services so far outweigh the risks that all patients with specific medical needs should receive them. These services, such as beta-blockers for heart attack patients, are backed by well-articulated medical theory and strong evidence of efficacy, determined by clinical trials or valid cohort studies.
Electronic Health (Medical) Record (EHR or EMR)—The Electronic Health (Medical) Record (EHR or EMR) is a computerized medical file that contains the history of a patient’s medical care, commonly abbreviated as “EHR,” in contrast to “PHR,” which stands for personal health record., An EHR or EMR enables patients to transport their health care information with them at all times.
Emergency department—is the department within a health care facility that is intended to provide rapid treatment to victims of sudden injury or illness. Emergency Departments across the nation struggle with overcrowding, long patient wait periods and shortages of health care professionals.
Episodes of care—An episode of care is a concept that focuses on a health condition from its inception through evaluation and treatment as a means of measuring both the quality of care received and the efficiency of the care provided.
Evidence-based medicine—Evidence-based medicine is the use of the current, 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 is central to developing performance measures for the most common and costly health conditions. The measures allow consumers to compare medical providers and learn which ones routinely offer the highest quality, safest and most effective care.
Federally qualified health center (FQHC)—A federally qualified health center is a health organization that offers primary care and preventative health services to all patients regardless of their ability to pay for care. A FQHC must be a public or private nonprofit organization and meet specific criteria to receive government funding.
Fee schedule—A fee schedule is a complete listing of fees used by health plans to pay doctors or other providers.
Fee-for-service—Fee-for-service is an arrangement under which patients or a third party pay physicians, hospitals, or other health care providers for each encounter or service rendered.
Health Plan Employer Data and Information Set (HEDIS) Measures—The Health Plan Employer Data and Information Set (HEDIS) Measures are a set of health care quality measures designed to help purchasers and consumers determine how well health plans follow accepted care standards for prevention and treatment. Formerly known as the Health Plan Employer Data Information Set, health plans can receive accreditation on HEDIS measures from certain organizations, such as the National Committee on Quality Assurance.
Health Resources and Services Administration (HRSA)—The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services and is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable.
Health information technology (HIT)—Health information technology is a global term (which encompasses electronic health records and personal health records) to indicate the use of computers, software programs, electronic devices and the Internet to store, retrieve, update and transmit information about patients’ health.
Hospital CAHPS (H-CAHPS or CAHPS Hospital Survey)—Hospital CAHPS (H-CAHPS or CAHPS Hospital Survey) is a standardized survey instrument and data collection methodology for measuring patients’ perspectives of hospital care. While many hospitals collect information on patient satisfaction, there is no national standard for collecting or publicly reporting this information that would enable valid comparisons to be made across all hospitals. H-CAHPS is a core set of questions that can be combined with customized, hospital-specific items to produce information that complements the data hospitals currently collect to support improvements in internal customer service and quality-related activities.
Hospital Quality Alliance (HQA)—The Hospital Quality Alliance (HQA) is a public-private collaboration seeking to improve the quality of care provided by the nation’s hospitals by measuring and publicly reporting on that care.
Hospital discharge—Hospital discharge is the process by which a patient is released from the hospital by health care professionals.
Hospital referral regions (HRRs)—Hospital referral regions are used by the Dartmouth Atlas of Health Care to define regional health care markets. These regions are defined by where patients in surrounding areas are most often referred to for tertiary care. Each HRR contains at least one hospital that performs major cardiovascular procedures and neurosurgery. HRRs can cross state lines.
Improving chronic illness care (ICIC)—Improving chronic illness care (ICIC) is an organization that has worked for almost 10 years with national partners toward the goal of bettering the health of chronically ill patients by helping health systems, especially those that serve low-income populations, improve their care through implementation of the chronic care model.
Improving performance in practice (IPIP)—The improving performance in practice (IPIP) initiative is a project within the North Carolina Academy of Family Physicians. The program seeks to establish a designated Quality Improvement Consultant (QIC) to work onsite with the practice leadership team to develop a practice-specific redesign plan utilizing the resources of collaborating experts.
Informed decision-making (IDM)—Informed decision-making is a term to describe a process designed to help patients understand the nature of the disease or condition being addressed; understand the clinical service being provided including benefits, risks, limitations, alternatives and uncertainties; consider their own preferences and values; participate in decision-making at the level they desire; and make decisions consistent with their own preferences and values or choose to defer a decision until a later time.
Inpatient care—Inpatient care is the delivery of health care services to a person who has been admitted to a hospital or other health facility for a period of at least 24 hours.
Input—Input is the flow of patients into a medical facility, such as an emergency department.
Institute for Healthcare Improvement (IHI)—The Institute for Healthcare Improvement (IHI) is an independent nonprofit organization helping to lead the improvement of health care throughout the world. Founded in 1991 and based in Cambridge, Mass., IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.
Institute of Medicine (IOM)—The Institute of Medicine (IOM) is a nonprofit organization and honorific membership organization that works outside the framework of government to ensure scientifically informed analysis and independent guidance on matters of biomedical science, medicine and health. The Institute provides unbiased, evidence-based and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society and the public at large. IOM’s book on quality and safety, Crossing the Quality Chasm: A New Health System for the 21st Century, partially funded by the Robert Wood Johnson Foundation, reported that a huge divide exists between the care we should receive and the care that we get. Crossing the Quality Chasm introduces the notion that health care needs to take a page from industry and use its engineering improvement methods to aim for top quality, efficiency and safety. The report lays out six goals that would become akin to a mantra for the quality improvement movement: care should be “safe, effective, patient-centered, timely, efficient and equitable.” IOM’s 2003 landmark report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care demonstrates the reality and effect of health disparities and quality-of-care differences for persons of racial and ethnic minorities.
Joint Commission (JCAHO) formerly: Joint Commission on Accreditation of Healthcare Organizations—The Joint Commission (JCAHO) is a private, nonprofit organization that evaluates and accredits hospitals and other health care organizations providing home care, behavioral health care, ambulatory care and long-term care services.
Meaningful use— Meaningful use is a qualification to receive federal funding for health information technology. For instance, if a health information technology (HIT) system is used in a meaningful way to provide better patient care, a health system can qualify to receive federal subsidies to help to pay for the technology.
Medical error—A medical error is a mistake that harms a patient. Adverse drug events, hospital-acquired infections and wrong-site surgeries are examples of preventable medical errors.
Misuse—Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of misuse.
Models of care—A model of care is a conceptual object or diagram that provides an outline of how to plan all current and future facility and clinical service. It is important that the Model of Care be designed and evaluated for its ability to be replicated within the health care system. Models of care can help guide and direct a patient’s experience within a health care system.
Multi-disciplinary teams/multidisciplinary—Multi-disciplinary teams are health care teams made up of health care professionals as well as health educators or community leaders.
National Committee on Quality Assurance (NCQA)—The National Committee on Quality Assurance (NCQA) The National Committee on Quality Assurance (NCQA) is a private, nonprofit organization dedicated to improving health care quality through measurement, transparency and accountability. NCQA has been a central figure in driving improvement throughout the health care system, helping to elevate the issue of health care quality to the top of the national agenda. The organization has helped build consensus around important health care quality issues by working with large employers, policy-makers, doctors, patients and health plans to decide what’s important, how to measure it and how to promote improvement.
National Health Plan Collaborative (NHPC)—The National Health Plan Collaborative (NHPC) is a project bringing together 11 major health insurance companies, in partnership with organizations from the public and private sectors, to identify ways to improve the quality of health care for racially and ethnically diverse populations. Together, member health plans reach more than 87 million Americans.
National Institutes of Health (NIH)—The National Institutes of Health (NIH) is a part of the U.S. Department of Health and Human Services, the primary federal agency for conducting and supporting medical research. Helping to lead the way toward important medical discoveries that improve people’s health and save lives, NIH scientists investigate ways to prevent disease as well as the causes, treatments, and even cures for common and rare diseases.
National Quality Forum (NQF)—The National Quality Forum (NQF) is a nonprofit membership organization created to develop and implement a national strategy for health care quality measurement and reporting. Established as a public-private partnership, the NQF has broad participation from all parts of the health care system, including national, state, regional and local groups representing consumers, public and private purchasers, employers, health care professionals, provider organizations, health plans, accrediting bodies, labor unions, supporting industries and organizations involved in health care research or quality improvement. Together, the organizational members of the NQF work to promote a common approach to measuring health care quality and fostering system-wide capacity for quality improvement. Quality improvement measures endorsed by the NQF are considered the gold standard.
Outpatient care—Outpatient care is medical or surgical care that does not include an overnight hospital stay.
Output—Output is the flow of patients out of a medical facility, such as an emergency department.
Overcrowding—Overcrowding is a situation experienced by many emergency departments across the nation where there are too many patients for the number of physicians available. This causes excessive time spent waiting for care, unhappy patients and poor-quality care provided to patients.
Overuse—Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.
Patient experience—The patient experience is comprised of research reports and administrative information that reflect quality from the perspective of patients by capturing observations and opinions about what happened during the process of health care delivery. Patient experience encompasses various indicators of patient-centered care, including access (whether patients are obtaining appropriate care in a timely manner), communication skills, customer service, helpfulness of office staff and information resources.
Patient flow—Patient flow is the movement of patients who seek care in an emergency department through the admission process. This is the process through which patients are granted entry for care at the hospital and seen by a physician.
Patient registry—A patient registry is a patient database maintained by a hospital, doctors’ practice or health plan that allows providers to identify their patients according to disease, demographic characteristics and other factors. Patient registries can help providers better coordinate care for their patients, monitor treatment and progress and improve overall quality of care.
Patient satisfaction—Patient satisfaction is a measurement designed to obtain reports or ratings from patients about services received from an organization, hospital, physician or health care provider.
Patient-centered care—Patient-centered care considers patients’ cultural traditions, personal preferences and values, family situations and lifestyles. Responsibility for important aspects of self-care and monitoring is put in patients’ hands—along with the tools and support they need. Patient-centered care also ensures that transitions between different health care providers and care settings are coordinated and efficient. When care is patient-centered, unneeded and unwanted services can be reduced.
Patient-centered medical home (PCMH)—A patient-centered medical home is health care model that aims to provide structured, proactive and coordinated care for patients rather than episodic treatments for illnesses. In a medical home, the primary-care doctor operates as a “home base” for patients, overseeing all aspects of patients’ health and coordinates care with any specialists involved in the patient’s care.
Pay-for-performance (P4P)—Pay-for-performance (P4P) is a method for paying hospitals and physicians based on their demonstrated achievements in meeting specific health care quality objectives. The idea is to reward providers for the quality—not the quantity—of care they deliver.
Payers—Payers comprise the entity that assumes the risk of paying for medical treatments. Examples include uninsured patients, self-insured employers, health plans or HMOs.
Payment reform—Payment reform seeks to improve current mechanisms for reimbursing providers by including rewards for provider quality in the reimbursement mechanisms.
Performance measures—Performance measures are sets of established standards against which health care performance is measured. Performance Measures are now widely accepted as a method for guiding informed decision-making as a strong impetus for improvement.
Personal health record (PHR)—A personal health record (PHR) contains the medical and health-related background documents pertaining to a consumer.
Physician quality reporting initiative (PQRI)—The physician quality reporting initiative (PQRI) is authorized through the Medicare, Medicaid, and SCHIP Extension Act of 2007. It is a financial incentive for health care professionals to improve the quality of care that they provide.
Preference-sensitive care—Preference-sensitive care are treatments that involve significant tradeoffs affecting the patient’s quality and/or length of life. Decisions about these interventions—whether to have them or not, which ones to have—ought to reflect patients’ personal values and preferences, and ought to be made only after patients have enough information to make an informed choice. At times, the scientific evidence on the main outcome—survival—is quite good; in other cases, the evidence is much weaker.
Preventive care—Preventive care is health care services that prevent disease or its consequences. It includes primary prevention to keep people from getting sick (such as immunizations), secondary prevention to detect early disease (such as Pap smears) and tertiary prevention to keep ill people or those at high risk of disease from getting sicker (such as helping someone with lung disease to quit smoking).
Price transparency—Price transparency is the ability of consumers to know what it will cost to receive a given health care service at a variety of outlets.
Primary care—Primary care is basic or general health care traditionally provided by doctors trained in: family practice, pediatrics, internal medicine and occasionally gynecology.
Process improvement—Process improvement comprises techniques and strategies used to make the processes implemented to solve health care problems better. Process improvement can occur in emergency room or hospital settings, as well as in other health-system environments.
Provider—A provider is a professional engaged in the delivery of health services, including physicians, dentists, nurses, podiatrists, optometrists, clinical psychologists, etc. Hospitals and long-term care facilities are also providers. The Medicare program uses the term “provider” more narrowly, to mean participating institutions: hospitals, skilled nursing facilities, home health agencies, etc.
Provider incentives—Provider incentives serve to induce or motivate the regulation of health care. Examples of incentives include monetary rewards for providers who meet specific benchmark standards for their patient care.
Public reporting—Public reporting makes information about physician and physician group performance available for consumers to use to compare the performance of local physicians/physician groups. The expectation is that a comparative public report of local physicians’ performance in treating people with chronic illnesses will motivate and improve performance.
Purchasers—Purchasers comprise the entity that not only pays the premium for health care costs, but also controls the premium dollar before paying it to the provider. Included in the category of purchasers or payers are patients, businesses and managed care organizations. While patients and businesses function as ultimate purchasers, managed care organizations and insurance companies serve a processing or payer function.
Quality (of care)—Quality (of care) is a measure of the ability of a doctor, hospital or health plan to provide services for individuals and populations that increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Good quality health care means doing the right thing at the right time, in the right way, for the right person and getting the best possible results. According to the mantra for the quality improvement movement, care should be “safe, effective, patient-centered, timely, efficient and equitable.”
Quality (of life)—Quality (of life) is the amount of happiness and balance in an individual’s life. Attention to good health will create a better quality of life.
Quality Alliance Steering Committee (QASC)—The Quality Alliance Steering Committee (QASC) is a broad-based coalition of physicians, consumers, purchasers, health insurance plans and others who seek to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring performance at the physician or group level; collecting and aggregating data in the least burdensome way; and reporting meaningful information to consumers, physicians and other stakeholders to inform choices and improve outcomes.
Quality improvement (QI)—Quality improvement (QI) is a term first coined in the private sector, when corporations began looking at ways to streamline and improve processes and systems. The most well-known example of quality improvement methodology is the “Six Sigma” method of change, developed by engineers at Motorola. In the health care context, the goal of quality improvement strategies is for patients to receive the appropriate care at the appropriate time and place with the appropriate mix of information and supporting resources. In many cases, health care systems are designed in such a way as to be overly cumbersome, fragmented, and indifferent to patients’ needs. Quality improvement tools range from those that simply make recommendations but leave decision-making largely in the hands of individual physicians (e.g., practice guidelines) to those that prescribe patterns of care (e.g., critical pathways). Typically, quality improvement efforts are strongly rooted in evidence-based procedures and rely extensively on data collected about processes and outcomes.
Quality indicator—A quality indicator is 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 measures—Quality measures are mechanisms used to assign a quantity to quality of care by comparison to a criterion.
Rapid cycle change—Rapid cycle change is a quality-improvement method that identifies, implements and measures changes made to improve a process or a system. At the onset, the team sets an outcome measure based on the system’s goals. Improvement occurs through small, rapid PDSA (Plan, Do, Study, Act) cycles to advance practice change. This model requires targeting a specific area to change; planning changes on the basis of sound science, theory and evidence; piloting several changes with small patient groups; measuring the effects of changes; and acting according to the data. The fundamental concept of rapid-cycle improvement is that health care processes—once defined, in place and in effect—should be continually improved by instituting a constant cycle of innovations or improvements.
Report card—A report card is an assessment of the quality of care delivered by health plans. Report cards provide information on how well a health plan treats its members, keeps them healthy and provides access to needed care. Report cards can be published by states, private health organizations, consumer groups or health plans.
Resource use—Resource use is the amount of health care services used for a patient, including the number, cost and intensity of services provided.
Return on investment (ROI)—A return on investment (ROI) is the amount of improvement in care brought about by a certain investment. ROI can also refer to the theory that if you invest in health care quality now, then the quality of care for patients will improve in the future.
Right care—Right care is made up of the treatments that, according to evidence-based guidelines, are effective and appropriate for a given condition. Indicators used to define right care are often grouped into two categories: prevention and chronic care.
Self-management—Self-management is the ability of individuals to have the necessary knowledge, attitudes and skills to manage their health problems or disorders on a day-to-day basis. It is a skill that enables individuals, and their families, to make improved use of existing health services, as well as make choices surrounding health care providers, medication, diet, exercise and other lifestyle issues that protect or damage health.
Sentinel event—A sentinel event is any unexpected event in a health care setting that causes death or serious injury to a patient and is not related to the natural course of the patient’s illness.
Specialty care—Specialty care is health care focused on improving the well being of certain specialized categories of health, as opposed to general and overall health and well-being. To improve the quality of health care available to consumers and patients, providers must improve the quality and availability of primary and specialty care.
Standard of care—The standard of care is the expected level and type of care provided by the average caregiver under a certain given set of circumstances. These circumstances are supported through findings from expert consensus and based on specific research and/or documentation in scientific literature.
Supply-sensitive care—Supply-sensitive care includes excess procedures, hospital admissions and doctor visits driven by the supply of doctors and hospital resources, rather than by need.
Transparency—Transparency is the process of collecting and reporting health care cost, performance and quality data in a format that can be accessed by the public and is intended to improve the delivery of services and ultimately improve the health care system as a whole.
Underuse—Underuse refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).
Value purchasing—Value purchasing is a broad strategy used by some large employers to get more value for their health care dollars by demanding that health care providers meet certain quality objectives or supply data documenting their use of best practices and quality treatment outcomes.
Variation—Variation is an instance of change or deviation. There is unwarranted variation in the practice of medicine and the use of medical resources in the United States. There is underuse of effective care, such as the use of beta-blockers for people who have heart attacks and screening of diabetics for early signs of retinal disease. There is misuse of preference-sensitive care, such as the choice between mastectomy and lumpectomy for early-stage breast cancer. And there is overuse of supply-sensitive care, such as admitting patients with chronic conditions like diabetes to the hospital, rather than treating them as outpatients.
Work flow—Work flow is a repeatable pattern of activity enabled by the organization of resources, defined roles, and information into a process that can be documented and learned. Improvements in work flow for health care providers will lessen the burden of providing health care and will lead to greater quality health care overall.