Need help in understanding healthcare jargon? Here are consumer-friendly definitions for some of the most commonly used terms and acronyms.
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Accredited/Accreditation means that a healthcare organization or facility has met certain quality standards that have been established by nationally recognized authorities and has received their “seal of approval.” Among the organizations that accredit AtlantiCare are the Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org), American College of Surgeons (http://www.facs.org/) and College of American Pathologists (http://www.cap.org/apps/cap.portal).
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.
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, emergency departments, outpatient surgery centers and hospital settings that do not involve a patient staying overnight.
Board certified means a doctor has received special training and passed an advanced exam in a particular area of medicine. Primary care doctors as well as specialists may be board certified.
Board certification is different than licensing. Every physician must be licensed by the state to practice medicine. However, a physician may practice a specialty without being board certified.
Centers for Medicare and Medicaid Services (CMS) (http://www.medicare.gov/) is the federal agency that operates the Medicare program. In addition, CMS works with states to manage the Medicaid program. Among CMS’s goals is to ensure that the beneficiaries in these programs receive high-quality healthcare.
Certified/Certification means that a healthcare facility has successfully completed a survey conducted by a state government agency.
Clinical Practice Guidelines are documents that help physicians and their patients make decisions about appropriate healthcare 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.
Clinical trials are carefully controlled research studies involving people that help lead to better prevention, diagnosis and treatment for diseases.
Consumer-driven healthcare is a term that refers to health plans that offer employees personal accounts, such as Health Savings Accounts, Flexible Spending Accounts and Health Reimbursement Accounts. These accounts are “consumer driven” in that they give participants greater control over their own healthcare, allowing individuals to determine on a personal basis how they choose to spend their healthcare account funds.
Diagnosis-Related Group (DRG) is a way to categorize patients, especially Medicare patients, based on diagnosis, age, type of surgical procedure used, expected length of hospital stay and other criteria. The DRG determines the fixed payment amount that a hospital receives to care for a patient, regardless of what actual costs are incurred.
Discharge planning involves deciding what a patient needs to ensure a smooth transition from one level of care to another – for example, moving from a hospital unit to a nursing home or to home care. Discharge planning is usually provided by a social worker or other healthcare professional.
Evidence-base medicine is the use of current, best evidence in making decisions about the care of patients.
Health Insurance Portability and Accountability Act (HIPAA) is a federal law passed in 1996 that helps guarantee healthcare plan eligibility for people who move from one employer to another. It also establishes national standards for healthcare information, including giving patients greater access to their own medical records and more control over how their personally identifiable health information is used. Additional information is available through the Office of Civil Rights (http://www.hhs.gov/ocr/hipaa/).
Health savings account is a tax-free account used to pay for routine medical expenses. Individuals, employers or both deposit funds into the account. A high-deductible insurance policy accompanies the account to pay for catastrophic medical expenses in the event of a major injury or illness. Health savings account holders are motivated to use the funds wisely and to compare healthcare provider costs and values, since unspent funds are allowed to accumulate in these accounts.
Hospital Quality Initiative was launched by the Centers for Medicare and Medicaid Services (CMS) in 2002. Through this program, CMS distributes objective, easy-to-understand data on hospital performance. Initiatives include the development of Hospital Compare (www.hospitalcompare.hhs.gov), a web site that publicly reports data on the quality of care delivered in hospitals nationwide.
Institute of Medicine (IOM) (www.iom/edu) is a non-profit organization and part of the National Academies whose mission is to serve as a national advisor to improve healthcare.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (www.jcaho.org)is a private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations providing home care, behavioral healthcare, ambulatory care and long-term care services.
Nursing Magnet is a designation presented by the American Nurses Credentialing Center (http://www.ana.org/ancc/) to recognize organizations for excellence in nursing service. Magnet hospitals must satisfy a demanding set of criteria measuring the nursing team’s performance and strength over an extended time period.
Outcome is the change in a patient’s health status that can be attributed to the care received, such as a given healthcare service, prescription used or medical procedure.
Patient advocate is a hospital staff member who speaks on behalf of patients and ensures that they receive the information and services they require.
Patient Bill of Rights outlines what you should expect during a hospital stay with regard to your rights and responsibilities. AtlantiCare – and most other hospitals – provide you with a copy when you are admitted to the hospital.
Peer review involves a medical professional’s work being checked or examined by another medical professional of equal training (peer).
Plan of care is a document outlining the types of services and care a patient needs for treatment.
Quality assurance is the process of evaluating the quality of medical service provided, identifying opportunities for improvement and implementing changes as needed. The process also monitors and measures the results of improvement efforts.
Quality Improvement Organizations (QIO) are primarily not-for-profit, community-based organizations that work with physicians, hospitals and their patients to continually improve the quality and effectiveness of community healthcare. These organizations consist of a diverse staff of physicians, nurses, statisticians and other healthcare professionals.
Root Cause Analysis (RCA)is a structured, detailed review of the underlying causes and conditions that contribute to an unfavorable medical event or incident, such as a patient receiving the wrong medication or inappropriate treatment.
Safety Culture is an environment that supports and promotes safety at every level of the organization – from board members and senior management to frontline staff. Aspects include acknowledging safety concerns, encouraging error reporting, using teamwork to find solutions, and devoting resources to make positive changes.
Standard of Care is the expected level and type of care provided by the average caregiver under a certain given set of circumstances.
Systems Approach views medical errors and problems related to quality care as breakdowns in the system, rather than the fault of the individual care provider. It works by identifying situations likely to involve human error and making changes to the system that prevent errors from occurring and affecting patients.
Treatment is the process used to achieve a desired health status for a patient.
Treatment Options are alternative ways to care for a medical condition. xxx
Validation is the process of determining the reliability and accuracy of data.
World-class quality refers to excellence in quality performance – the best in the world.
Zero defects is a term that refers to flawless performance. To totally eliminate errors – or move closer to attaining that objective – requires great vigilance and attention to detail.