- Care Setting
- Ambulatory care
- Health care services provided to patients on an ambulatory basis, rather than by admission to a hospital or other health care facility. The services may be provided by a hospital augmenting its inpatient services, or may be provided at a free-standing facility.
- Ancillary services
- Supplemental services, including laboratory, radiology, physical therapy, and inhalation therapy that are provided in conjunction with medical or hospital care.
- Behavioral health care
- Health care services organized to provide mental health care, which may include diagnostic, therapeutic, and preventive mental health services, therapy and/or rehabilitation for substance-dependent individuals, and the use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments.
- Community health care
- Diagnostic, therapeutic, and preventive health care services provided for individuals or families in the community for the purpose of promoting, maintaining, or restoring health or minimizing the effects of illness and disability.
- Emergency medical services
- Services specifically designed, staffed, and equipped for the emergency care of patients.
- Home care
- Community health and nursing services providing coordinated multiple service home care to the patient. It includes home-offered services provided by visiting nurses, home health agencies, hospitals, or organized community groups using professional staff for care delivery.
- Hospices
- Facilities or services, which are especially devoted to providing palliative and supportive care to the patient with a terminal illness and to the patient's family.
- Hospitals
- Includes all hospital facilities such as community hospitals, general hospitals, group practice hospitals, packaged hospitals, private hospitals, public hospitals, satellite hospitals, rural hospitals, special hospitals, teaching hospitals, and urban hospitals.
- Long-term care facilities
- Facilities that provide rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of daily nursing supervision, limited medical care, and/or assistance with activities of daily living. Includes nursing homes, assisted living facilities, inpatient behavioral health facilities, and long-term chronic care hospitals.
- Managed care plans
- Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care, programs for reviewing the medical necessity of specific services, increased beneficiary cost sharing, controls on inpatient admissions and lengths of stay, the establishment of cost-sharing incentives for outpatient surgery, selective contracting with health care providers, and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as health maintenance organizations (HMO), independent practice associations (IPA), and preferred provider organizations (PPO), etc.
- Physician group practices/clinics
- Any groups of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income.
- Rehabilitation centers
- Facilities/programs that provide interventions and support services intended for rehabilitating individuals with mental illnesses or physical disabilities.
- Residential care facilities
- Facilities which provide supervision and assistance in activities of daily living with medical and nursing services when required, generally for those not needing hospital services but still in need of medical assistance. They are usually established as planned, single housekeeping units in residential dwellings that provide care and supervision for small groups of residents, who, although unrelated, live together as a family. Includes group homes, halfway houses, and orphanages.
- Rural health care
- Health care services, public or private, in rural areas. The services include the promotion of health and the delivery of health care.
- Substance use treatment programs/centers
- Facilities/programs providing therapy and/or rehabilitation for substance-dependent individuals. Includes inpatient programs and outpatient programs (e.g., methadone distribution centers).
- Case Finding
- The procedure for determining whether a case is potentially eligible for inclusion in the denominator of a measure. It is the concept of establishing a sampling frame from which a more highly specified selection of cases will be made.
- Current Use of the Measure
- A measure is considered to be in current use if at least one health care organization has used the measure to evaluate or report on the quality of care within the last three years.
- Denominator (Index) Event
- The event or state that defines a case as eligible for inclusion in the denominator.
- Denominator Sampling Frame
- The list of all cases potentially eligible for inclusion in the denominator, from which a more highly specified selection of cases will be made.
- Enrollees or beneficiaries
- Enrollees are persons who have registered with a managed care plan to be eligible to receive health care. Beneficiaries are persons eligible for coverage of health care services by either a public or private health insurance program.
- Geographically defined
- Persons located within a specified boundary (e.g., a country, a state or region).
- Patients associated with provider
- Persons receiving or eligible to receive health care by a health care professional or organization.
- Denominator Time Window
- The time period in which cases are reviewed for inclusion in the denominator.
- Time window brackets index event
- Example: Prenatal care patients who were continuously enrolled at least 43 days prior to delivery through 56 days after delivery, where delivery is the index event.
- Time window follows index event
- Example: Patients discharged post myocardial infarction (MI) who survived for six months where hospital discharge following MI is the index event.
- Time window is a fixed period of time
- Example: Individuals continuously enrolled in a health plan for the 12-month period beginning January 2002 who receive a member satisfaction survey.
- Time window is a single point in time
- Example: Patients receiving a satisfaction survey at their most recent visit where the visit is the index event.
- Time window precedes index event
- Example: Patients with newly diagnosed cases of otitis media where the index event is the new diagnosis, with a new diagnosis defined by checking that care for otitis media was not given 3 months prior to the index event.
- Domains
- Access to care
- Access to care is a patient's or enrollee's attainment of timely and appropriate health care.
- Outcome of care
- An outcome of care is a health state of a patient resulting from health care.
- Patient experience of care
- Experience of care is a patient's or enrollee's report concerning observations of and participation in health care.
- Population Health
- Population health is the state of health of a group of persons defined by geographic location, organizational affiliation or non-clinical characteristics. (Eligibility for measures of population health is not restricted to recipients of clinical care.)
- Process of care
- A process of care is a health care service provided to, on behalf of, or by a patient appropriately based on scientific evidence of efficacy or effectiveness.
- Structure of care
- Structure of care is a feature of a healthcare organization or clinician relevant to its capacity to provide health care.
- Use of Services
- A use of service is the provision of a service to, on behalf of, or by a group of persons defined by geographic location, organizational or non-clinical characteristics without determination of the appropriateness of the service for the specified individuals. Use of service measures can assess encounters, tests, interventions as well as the efficiency of the delivery of these services.
- Incidence
- Incidence is a rate, showing how many new cases of a disease occurred in a population during a specified interval of time (usually expressed as the number of new cases per unit time per fixed number of people [e.g., number of new cases of cancer per 10,000 persons in one year]).
1, 2
- Institute of Medicine (IOM)
- A private, nonprofit institution that provides objective, timely, authoritative information and advice concerning health and science policy to government, the corporate sector, the professions and the public under a congressional charter.
- Institute of Medicine (IOM) Care Needs
- End of life care
- Care related to those not expected to survive more than six months.
- Getting better
- Care related to acute illness or injury.
- Living with illness
- Care related to chronic or recurrent illness.
- Staying healthy
- Care related to healthy populations or the general health needs of non-healthy populations (e.g., health promotion, disease prevention, risk factor assessment, early detection by screening and treatment of pre-symptomatic disease).
- Institute of Medicine (IOM) Domains
- Effectiveness
- Relates to providing care processes and achieving outcomes as supported by scientific evidence.
- Efficiency
- Relates to avoiding waste, including waste of equipment, supplies, ideas, and energy.
- Equity
- Relates to providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
- Patient centeredness
- Relates to meeting patient's needs and preferences and providing education and support.
- Safety
- Relates to actual or potential bodily harm.
- Timeliness
- Relates to obtaining needed care while minimizing delays.
- Level of Determination of Quality
- Individual case
- Quality can be determined at the individual level (i.e., each individual
is subject to the assessment of whether they received quality care).
Individual scores can be aggregated to reflect care for the group (e.g.,
in the case where a measure is assessing the proportion of patients
screened for depression in a primary care setting, quality can be determined
at the individual level since screening a primary care patient is considered
good care).
- Not individual case
- Quality cannot be determined at the individual level but instead must be
determined at an aggregate level (i.e., a disproportionate rate of
occurrences within a group of patients, as compared to another group of
patients, may indicate a quality problem) (e.g., in the case where a
measure is assessing the rate of patients developing a nosocomial infection
after inpatient surgery, experiencing a post surgical infection is not
individually indicative of good or bad care; however, a high rate of
infections as a proportion of all surgical cases suggests a quality
problem).
- Level of Health Care Delivery Addressed
- Counties or cities
- Health care delivered across one or more counties or cities within a given
state.
- Group clinical practices
- Health care delivered by any group of three or more full-time physicians
organized in a legally recognized entity for the provision of health care
services, sharing space, equipment, personnel and records for both patient
care and business management, and who have a predetermined arrangement for
the distribution of income.
- Individual clinicians
- Health care delivered by an individual clinician, offering services on a
person-to-person basis, as opposed to group or partnership practice.
- Multisite health care organizations
- Health care delivered by a facility that is part of a larger organization
that has multiple sites across a given state, region, or nation, includes
integrated delivery systems.
- National
- Health care delivered across a single national entity (e.g., United States).
- Regional
- Health care delivered across one or more specific regions (e.g., Northeast
United States).
- Single health care delivery organizations
- Health care delivered by a single facility.
- States
- Health care delivered across one or more states.
- Numerator Time Window
- The time period in which cases are reviewed for inclusion in the numerator.
- Encounter or point in time
- A specific visit or point in time (e.g., the first visit in a sampling
period, the point at which a patient survey is administered, birth or death
date).
- Episode of care
- The course of health care for an illness or a condition as observed in the
chosen data source (e.g., the percentage of patients with a primary diagnosis
of schizophrenia who receive an antipsychotic medication between 300 and
600 CPZ equivalents per day during the maintenance phase of the illness).
- Fixed time period
- An explicit time frame for the receipt of care (e.g., January 1, 2002
through December 31, 2002).
- Institutionalization
- The care delivered in a hospital, rehabilitation hospital, or nursing home - from admission to discharge, regardless of length of stay (e.g., the proportion of patients in a psychiatric facility who are physically restrained during their hospitalization).
- Outcome Type
- Adverse outcome
- Example: An injury due to a medical treatment such as perforation of a viscus
during surgery.
- Clinical outcome
- Example: Level of hemoglobin A1c, a measure of control of glucose metabolism in
individuals with diabetes; change in symptoms; mortality as an outcome of a
clinical condition.
- Functional status
- A measure of an individual's ability to perform normal activities of life.
- Health risk state or behavior
- Example: Being a smoker as an outcome measure for smoking cessation counseling.
- Proxy for outcome
- A process of care used as an indicator of health status (e.g., an admission to hospital used as an indication of increased severity of illness).
- Quality of life measure
- Refers to "health-related quality of life based on those aspects of a
person's overall well-being that are affected by health status or health
care."3
- Prevalence
- Prevalence is the proportion of people in the entire population who have a disease at a certain point in time without regard to when they first got the disease.
2, 4
- Professionals Responsible for Health Care
- Advanced practice nurses
- Professionals qualified by education at an accredited school of nursing
and licensed by state law to practice nursing. These individuals typically
have a master's degree or higher. This category includes nurse administrators,
nurse anesthetists, nurse clinicians, nurse practitioners, nurse
psychotherapists, and nurse midwives.
- Allied health personnel
- Health care workers specially trained and licensed to assist and support
the work of health professionals. This group is designed to include most
assistive personnel and technicians, such as behavioral therapy assistants,
community health aides, dental assistants, dental hygienists, dental
technicians, home health aides, medical record administrators, medication
administration aides, nurses' aides, psychiatric aides, operating room
technicians, pharmacists' aides, and radiology technicians.
- Chiropractors
- Individuals specially trained and licensed to practice chiropractic.
- Clinical laboratory personnel
- Those health care professionals, technicians, and assistants staffing a health
care facility where specimens are grown, tested or evaluated and the results of
such are recorded. Includes clinical laboratory technician/medical laboratory
technician, clinical laboratory scientist/medical technologist, histologic
technician/technologist, and pathologists' assistant.
- Dentist
- Individuals licensed to practice dentistry.
- Dietitians
- Individuals with a legally recognized qualification in nutrition and
dietetics who apply the science of nutrition to the feeding and education
of groups of people and individuals in health and disease.5
- Emergency medical technicians/paramedics
- Personnel trained and certified to provide basic emergency care and life
support under the supervision of physicians and/or nurses. These services
may be carried out at the site of the emergency, in the ambulance, or in
a health care institution.
- Measure is not provider specific
- Measure does not apply to specific professionals.
- Nurses
- Professionals qualified by education at an accredited school of nursing and
licensed by state law to practice nursing. They provide services to patients
requiring assistance in recovering or maintaining their physical or mental
health.
- Occupational therapists
- Those persons legally qualified by education and training to engage in the
practice of occupational therapy, a field concerned with utilizing craft or
work activities in the rehabilitation of patients.
- Pharmacists
- Those persons legally qualified by education and training to engage in
the practice of pharmacy.
- Physical therapists
- Those persons legally qualified by education and training to engage in the practice of
physical therapy, a field concerned with the use of special techniques to prevent, correct, and
alleviate movement dysfunction of anatomic or physiologic origin.
- Physician assistants
- Persons academically trained and licensed/credentialed to provide medical
care under the supervision of a physician.
- Physicians
- Individuals licensed to practice medicine. This category also includes all
physician specialists (e.g., psychiatrists).
- Podiatrists
- Individuals licensed to practice podiatry, the diagnosis and treatment of
foot disorders and injuries and anatomic defects of the foot.
- Psychologist/non-physician behavioral health clinicians
- Persons legally qualified by education and training to practice in the
field of mental health (e.g., psychology, counseling, and behavioral health).
- Public health professionals
- Persons educated in public health or a related discipline who are employed to improve health of
populations. These professionals perform three core functions, assessment, policy development, and
assurance, as they relate to the prevention and control of disease and disability, and the promotion
of physical and mental health of populations on an international, national, state, or municipal level.
- Respiratory care practitioners
- Individuals trained and certified in the field of respiratory therapy.
- Social workers
- Individuals trained and certified in the field of social work (e.g., the
use of community resources, individual case work, or group work that
promotes the adaptive capacities of individuals in relation to their social
and economic environments).
- Speech-language pathologists
- Individuals trained and certified in the field of speech-language pathology,
a field dealing with the diagnosis and treatment of speech or language
disorders.
- Quality Measures
- Clinical performance
- The degree of accomplishment of desired health objectives by a clinician
or health care organization.
- Clinical performance measure
- A subtype of quality measure that is a mechanism for assessing the degree to
which a provider competently and safely delivers clinical services that are
appropriate for the patient in the optimal time period.
- Measure
- A mechanism to assign a quantity to an attribute by comparison to a criterion.
- Quality measure
- A mechanism to assign a quantity to quality of care by comparison to a criterion.
- Quality of care
- The degree to which health care services for individuals and populations
increase the likelihood of desired health outcomes and are consistent with
current professional knowledge.6
- Rationale for the Measure
- The rationale is a brief statement describing the patients and the specific aspect of health care to which the measure applies. The rationale may also include the evidence basis for the measure, and an explanation of how to interpret results.
- Reliability
- The degree to which the measure is free from random error.
- Scoring of the Measure
- Categorical variable
- A categorical variable groups items into pre-defined discrete, non-continuous classes (male, female), (board certified, not board certified).
Categories may reflect a natural order, in which case they are called ordinal (cancer stage: I, II, III, or IV), (hospitals rankings: good, better, best).
- Continuous variable
- A measure score in which each individual value for the measure can fall
anywhere along a continuous scale (e.g., mean time to thrombolytics which
aggregates the time in minutes from a case presenting with chest pain to the
time of administration of thrombolytics).
- Frequency distribution
- A display of cases divided into mutually exclusive and contiguous
groups according to a quality-related criterion.
- Non-weighted score/composite/scale
- A combination of the values of several items into a single summary value for
each case.
- Rate
- A score derived by dividing the number of cases that meet a criterion for
quality (the numerator) by the number of eligible cases within a given time
frame (the denominator) where the numerator cases are a subset of the
denominator cases (e.g., percentage of eligible women with a mammogram
performed in the last year).
- Ratio
- A score that may have a value of zero or greater that is derived by dividing
a count of one type of data by a count of another type of data (e.g., the
number of patients with central lines who develop infection divided by
the number of central line days).
- Weighted score/composite/scale
- A combination of the values of several items into a single summary value for each case where each item is differentially weighted (i.e., multiplied by an item-specific constant).
- Special or Unique Data Source
- A data source that is unique to an organization and inaccessible to outside entities or persons.
- Standard of Comparison
- External comparison at a point in time
- A comparison using the same measure for multiple comparable entities
(e.g., non-teaching hospitals, large health plans, or states).
- External comparison of time trends
- A comparison using the same measure for multiple comparable entities
tracking change over time.
- Internal time comparison
- A comparison using the same measure in the same organization at two or
more points in time to evaluate present or prior performance.
- Prescriptive standard
- A standard set as a goal that ought to be achieved, or as a threshold
that defines minimum performance. This standard may be derived from
studies using different measurement methods.
- Validity
- The degree to which the measure is associated with what it purports to measure.
- Vulnerable Populations
- Groups of persons who may be compromised in their ability to give informed
consent, who are frequently subjected to coercion in their decision making, or
whose range of options is severely limited, making them vulnerable to health care
quality problems.
- Children
- All infants, children, and adolescents (i.e., all individuals who have not reached the legal age for consent).
- Disabled
- Persons with physical or mental disabilities that affect or limit their
activities of daily living and that may require special accommodations.
These include cognitively disabled, communicatively disabled, mentally
disabled, and physically disabled.
- Frail elderly
- Older adults or aged individuals who are lacking in general strength and
are unusually susceptible to disease or to other infirmity.
- Homeless
- Persons who have no permanent residence, including children and adolescents
with no fixed place of residence.
- Illiterate/low-literate populations
- Persons with low levels of education.
- Immigrants
- Persons coming into a country of which he or she is not a native for the
purpose of setting up residence. This category is also defined to include
refugees, asylees, and undocumented aliens or immigrants.
- Medically uninsured
- Individuals or groups with no or inadequate health insurance coverage.
Those falling into this category usually comprise three primary groups:
the medically indigent, those with clinical conditions that make them
medically uninsurable, and the working uninsured.
- Mentally ill
- Persons diagnosed as having a syndrome of emotional, cognitive,
and/or perceptual problems leading to significant impairment of
functioning or behavior.
- Minority groups
- A subgroup having special characteristics within a larger group, often
bound together by special ties which distinguish it from the larger group.
- Non-English speaking populations
- Individuals who do not speak English or whose primary language is not
English.
- Poverty populations
- Persons living below the standard level of living of the community.
- Prisoners
- Individuals involuntarily confined in a penal institution, including persons sentenced under a criminal or civil statute, detained pending arraignment, trial, or sentencing and detained in other facilities under statutes or
commitment procedures providing alternative to criminal prosecution or incarceration in a penal institution.
- Rural populations
- Persons inhabiting rural areas or small towns classified as rural.
- Terminally ill
- Persons with an incurable or irreversible illness at the end stage that
will result in death within a short time.
- Transients/migrants
- Mobile, short-term residents who move, usually to find work.
- Urban populations
- Persons inhabiting a city or town, including metropolitan areas.
- Women
- Adult females including working women (who are engaged in gainful
activities usually outside the home), battered women (who are physically
and mentally abused over an extended period), and pregnant women.
