Acronyms (download PDF of Acronyms )
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
AAFP – American Academy of Family Physicians
ACA – Affordable Care Act
ACO – Accountable Care Organization
AF4Q – Aligning Forces for Quality
AHIP – America’s Health Insurance Plans
AHRQ – Agency for Healthcare Research and Quality
CAH – Critical Access Hospital
CAHPS – Consumer Assessment of Healthcare Providers and Systems
CCT – Community Care Team
CDC – U.S. Center for Disease Control and Prevention
CHW – Community Health Worker
CME – Continuing Medical Education
CMS – Centers for Medicare and Medicaid Services
CPOE – Computerized Provider Order Entry
CQM- Clinical Quality Measure
DRGS – Diagnosis-related group
EHR or EMR – Electronic Health (Medical) Record
EMS – Emergency Medical Services
EP – Eligible Provider as defined by CMS
FQHC – Federally Qualified Health Center
HBA1c – Hemoglobin A 1 C
HEDIS – Health Plan Employer Data and Information Set Measures
HCAHPS – Hospital Consumer Assessment of Healthcare Providers and Systems
HER – Health Electronic Record
HHS – Department of Health and Human Service
HIT – Health Information Technology
HRSA – Health Resources and Services Administration
HTN or HBP – Hypertension or High Blood Pressure
IDM – Informed decision-making
IHI – Institute for Healthcare Improvement
IOM – Institute of Medicine
JCAHO – Joint Commission on Accreditation of Healthcare Organizations
MU – Meaningful Use
NCQA – National Committee for Quality Assurance
NIH – National Institutes of Health
NQF – National Quality Forum
ONC – Office of the National Coordinator for Health Information Technology
PCMH – Patient Centered Medical Home
PDSA Cycle – Plan Do Study Act Cycle
PHO – Physician Hospital Organization
PI – Performance Improvement/ QI – Quality Improvement
PPACA – Patient Protection and Affordable Care Act
PQRS – Physician Quality Reporting System formerly Physician quality reporting initiative (PQRI)
P4P – Pay-for-performance
QIO – Quality Improvement Organization
REC – Regional Extension Centers
ROI – Return on investment
RVUs – Relative value units
SIM Initiatives – State Innovation Models
UDS – Uniform Data System
VBP – Value-Based Purchasing
Glossary of Terms (download PDF of Glossary )
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
Accountable Care Organization (ACO)
A healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursement to quality metrics and reductions in the total cost of care for an assigned population of patients.
Affordable Care Act (ACA)
A federal statute signed into law in March 2010 as a part of the healthcare reform agenda of the Obama administration.
Agency for Healthcare Research and Quality (AHRQ)
As one of 12 agencies within the Department of Health and Human Services, AHRQ supports research that helps people make more informed decisions and improves the quality of health care services.
Aligning Forces for Quality (AF4Q)
A national program of the Robert Wood Johnson Foundation (RWJF) designed to help communities across the country improve the quality of health care for patients with chronic conditions such as diabetes, asthma, depression and heart disease.
America’s Health Insurance Plans (AHIP)
America’s Health Insurance Plans is the national association representing nearly 1,300 member companies providing health insurance coverage to more than 200 million Americans.
American Academy of Family Physicians (AAFP)
Representing more than 110,600 family physicians, residents, and medical student members, the AAFP is committed to helping family physicians improve the health of Americans by advancing the specialty of family medicine. Their focus is to help family physicians spend more time doing what they do best: providing quality and cost-effective patient care.
Centers for Medicare and Medicaid Services (CMS)
A division of HHS that administers the Medicare program and some aspects of state Medicaid programs.
Clinical Quality Measure (CQM)
Tools that help us measure and track the quality of healthcare services provided by eligible professionals (EPs), eligible hospitals (EHs), and critical access hospitals (CAHs) within our health care system.
Community Care Team (CCT)
The Community Care Team is a multidisciplinary team that partners with primary care offices (certified health care homes), the hospital, and existing health and social service organizations. The goal is to provide citizens with the support they need for well-coordinated preventive health services and coordinated linkages to available social and economic support services.
Community Health Worker (CHW)
A frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and improve the quality and cultural competence of service delivery.
Computerized Provider Order Entry (CPOE)
A process of electronic entry of medical practitioner’s instructions for the treatment of patients (particularly hospitalized patients) under his or her care.
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.
Continuing Medical Education (CME)
Education for medical professionals (i.e., a physician learns new medical techniques or technologies).
Critical Access Hospital (CAH)
A hospital certified under a set of Medicare Conditions of Participation (CoP), which are structured differently than the acute care hospital CoP. Some of the requirements for CAH certification include having no more than 25 inpatient beds; maintaining an annual average length of stay of no more than 96 hours for acute inpatient care; offering 24-hour, 7-day-aweek emergency care; and being located in a rural area, at least 35 miles drive away from any other hospital or CHA.
Department of Health and Human Service (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.
Diagnosis-related group (DRGS)
A patient classification system adopted on the basis of diagnosis consisting of distinct groupings.
Electronic Health (Medical) Record (EHR or EMR)
The Electronic Health (Medical) Record 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 Medical Services (EMS)
An integrated, federally assisted system of health manpower, facilities, and equipment providing all necessary emergency care in a defined geographic area.
Eligible Provider as defined by CMS (EP)
Providers who are eligible for covered professional services paid under or based on the Medicare Physician Fee Schedule (PFS). Medicare Eligible professionals include: doctor of medicine or osteopathy, doctor of dental surgery or dental medicine, doctor of podiatry, doctor of optometry, chiropractor. Medicaid Eligible professionals include: physicians (primarily doctors of medicine and doctors of osteopathy), nurse practitioner, certified nurse-midwife, dentist, physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant. Medicaid EPs must meet one of the following criteria: have a minimum 30% Medicaid patient volume; have a minimum 20% Medicaid patient volume, and is a pediatrician; practice predominantly in a Federally Qualified Health Center or Rural Health Center and have a minimum 30% patient volume attributable to needy individuals.
Federally Qualified Health Center (FQHC)
Includes all organizations receiving grants under Section 330 of the Public Health Service Act. Must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors.
Health Electronic Record (HER)
Also known as EHR (Electronic Health Record) or EMR (Electronic Medical Record), a computerized medical file that contains the history of a patient’s medical care.
Health Information Technology (HIT)
Computer-based tools developed specifically for health care delivery.
Health Plan Employer Data and Information Set Measures (HEDIS)
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.
Health Resources and Services Administration (HRSA)
The Health Resources and Services Administration 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.
Hemoglobin A 1 c (HBA1c)
A lab test that shows the average level of blood sugar (glucose) over the previous 2 to 3 months. It shows how well you are controlling your diabetes.
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
A standardized survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience.
Hypertension (HTN) or High Blood Pressure (HBP)
A common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. It is usually indicated by an adult systolic blood pressure of 140mm Hg or greater or a diastolic blood pressure of 90mm HG or greater.
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.
Institute for Healthcare Improvement (IHI)
An independent not-for-profit organization based in Cambridge, Massachusetts, IHI is a leading innovator in health and health care improvement worldwide.
Institute of Medicine (IOM)
An independent, non-profit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
An independent, not-for-profit group in the United States that administers accreditation programs for hospitals and other healthcare-related organizations.
Meaningful Use (MU)
The Recovery Act specifies the following 3 components of Meaningful Use: use of certified EHR in a meaningful manner (e.g., e-prescribing), use of certified EHR technology for electronic exchange of health information to improve quality of health care, use of certified EHR technology to submit clinical quality measures (CQM) and other such measures selected by the Secretary.
National Committee for Quality Assurance (NCQA)
A national organization that accredits quality assurance programs in prepaid managed health care organizations.
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.
National Quality Forum (NQF)
A not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.
Office of the National Coordinator for Health Information Technology (ONC)
The Office of the National Coordinator for Health Information Technology is a government organization that coordinates nationwide efforts to promote and implement the use of health information technology and electronic health records.
Care that considers patients’ cultural traditions, their personal preferences and values, their family situations and their lifestyles.
Patient Centered Medical Home (PCMH)
A way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.” Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.
Patient Protection and Affordable Care Act (PPACA)
The Patient Protection and Affordable Care Act is the full title of the comprehensive health care reform law enacted in March 2010.
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.
Performance Improvement (PI)/Quality Improvement (QI)
In health care, PI refers to the use of concurrent systems to improve quality. PI programs usually use tools such as task forces, statistical studies, cross-functional teams, process charts, etc.
Physician Hospital Organization (PHO)
A physician-hospital organization (PHO) is a joint venture between one or more hospitals and a group of physicians. It acts as the single agent for managed care contracting, presenting a united front to payers. In some cases, the PHO provides administrative services, credentials physicians and monitors utilization.
Physician Quality Reporting System (PQRS) (formerly Physician Quality Reporting Initiative – PQRI)
A program that provides a financial incentive to physicians and other eligible professionals who successfully report quality data related to covered services provided under the Medicare Physician Fee Schedule.
Plan Do Study Act Cycle (PDSA Cycle)
A component of the Model for Improvement which involves testing changes on a small scale before full implementation, a quality improvement tool.
Plan – a specific planning phase
Do – a time to try the change and observe what happens
Study – an analysis of the results of the test
Act – devising next steps based on the analysis
Quality Improvement Organization (QIO)
Designated by CMS, QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among under-served populations.
Regional Extension Center (REC)
An organization that has received funding under the Health Information Technology for Economic & Clinical Health Act to assist health care providers with the selection and implementation of electronic health record technology.
Relative value units (RVUs)
RVUs are a measure of value used in the United States Medicare reimbursement formula for physician services.
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.
State Innovation Models (SIM Initiatives)
The State Innovation Models Initiative is providing up to $300 million to support the development and testing of state-based models for multi-payer payment and health care delivery system transformation with the aim of improving health system performance for residents of participating states.
The use of electronic communication networks for the transmission of information and data focused on health promotion, disease prevention, and the public’s overall health including patient/community education and information, population-based data collection and management, and linkages for health care resources and referrals.
The practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, and health education, using interactive audio, video, or data communications.
Uniform Data System (UDS)
Contains the annual reporting requirements for recipients of the cluster of primary care grants funded by the Health Resources and Services Administration (HRSA).
U.S. Center for Disease Control and Prevention (CDC)
One of the major operating components of the Department of Health and Human Services. Its mission is to collaborate to create the expertise, information, and tools that people and communities need to protect their health.
Value-Based Purchasing (VBP)
Value-based 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.