Many of the terms and acronyms in this glossary were compiled and shared by health center teams that participated in a Health Disparities Collaborative (HDC), which focused on improving care for specific chronic conditions. New terms and acronyms have also been added that will aid health centers in understanding and carrying-out quality improvement (QI).
Note: For a list of general CHC-related Terms and Acronyms, please click HERE.
Agency for Healthcare Research and Quality (AHRQ)
One of 12 agencies within the Department of Health and Human Services (HHS), AHRQ supports research that helps people make more informed decisions and improve the quality of health care services. AHRQ was formerly known as the Agency for Health Care Policy and Research.
Aim or Aim Statement
A written, measurable, and time sensitive statement of the accomplishments a team expects to make from its improvement efforts. The aim statement contains a general description of the work, the population of focus, and the numerical goals.
Annotated Run Chart
A line chart showing results of improvement efforts plotted over time. The changes made are also noted on the line chart at the time they occur. This allows the viewer to connect changes made with specific results.
A numerical scale that teams can use to assess progress of participating teams toward reaching their aim. For example, 1= forming, and 5 = outstanding, sustainable improvement. In a quality improvement project, teams can use this scale to evaluate progress of the project as a whole as well as their own work.
Bureau of Primary Health Care (BPHC)
A bureau of the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), that funds and oversees health centers in underserved communities that provide access to high quality, family oriented, comprehensive primary and preventive health care to people who are low-income, uninsured or face other obstacles to getting care.
An individual in the organization who believes strongly in quality improvement and is willing to work with others to test, implement, and spread changes. Teams need at least one clinical champion. Champions from other disciplines who work on the process are important, as well. This champion should have a good working relationship with colleagues and be interested in driving change in the system.
A general idea for changing a process, usually developed by an expert panel based on literature and practical application of evidence. Change concepts are usually at a high level of abstraction, but evoke multiple specific ideas for how to change processes. “Simplify,” “reduce handoffs,” “consider all parties as part of the same system,” are all examples of change concepts.
An action-oriented, specific idea for changing a process. Change ideas can be tested to determine whether they result in improvements in the local environment.
A collection of change concepts and key changes.
Chronic Care Model (CCM)
A model that represents the ideal system of health care for people with chronic disease and an approach to re-designing health care to mirror that ideal system. The model has six components: community resources and policies, healthcare organization, self-management support, decision support, delivery system design, and clinical information systems.
Clinical Information System (CIS)
CIS incorporates the development of a comprehensive, integrated information system that is “patient-centered”, and includes patient registries and a practice management system including a billing system and electronic health records.
Clinical Quality Measures (CQM)
Defined by the Centers for Medicare and Medicaid (CMS) as tools that help measure or quantify health care processes, outcomes, patient perceptions, and organizational structures and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.
A systematic approach to healthcare quality improvement in which organizations test and measure practice innovations, then share their experiences in an effort to accelerate learning and widespread implementation of best practices. “Everyone teaches, everyone learns”.
All individuals from the participating organizations that drive and participate in the improvement process of a Collaborative. A core team of three to four individuals may attend a learning session, but a larger team, often from various disciplines, participates in the overall improvement process of the organization.
Core Team Members
Members are those individuals who attend the quality improvement meetings and/or learning sessions and are accountable to the senior leadership for the work of the quality improvement team or collaborative.
See PDSA Cycle.
Diabetes Electronic Management System (DEMS)
The clinical registry developed from the Diabetes Collaborative in 1999 in response to health centers’ need for clinical database support.
In the improvement process, someone within the organization who brings in new ideas from the outside, tries them, and uses experiences with positive results to persuade others in the organization to adopt the successful changes. Organizations who adopt new ideas or proceses before most other organizations in an idustry can also be coined early adopters.
The individuals in the organization, or organizations in an industry, who will adopt a change only after it is tested by an early adopter.
Electronic Health Record (EHR)
A systematic collection of electronic health information about an individual patient. It is a record in digital format that is capable of being shared across different health care settings. EHR’s may include a large range of data including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal status, and billing information.
Electronic Mailing List, E-Mail List, or Listserv
A communication system that allows teams to stay connected with the leadership team and each other during the action periods. Sharing information, getting questions answered, and solving problems are all part of e-mail list activity.
Electronic Medical Record (EMR)
Health Disparities Collaborative (HDC)
The large BPHC quality improvement collaborative that began in 1998 and ran for a decade to assist health centers with formalizing quality improvment efforts related to a number of chronic diseases.
Health Information System (HIS)
A system used to manage health data, often from an EHR, to provide information that health care ogranizations can use to make decisions.
Institute for Healthcare Improvement (IHI)
An independent not-for-profit organization working since 1991 to accelerate improvement in health care systems in the United States and internationally by fostering collaboration, rather than competition, among health care organizations, that are committed to health care reform.
Taking a change and making it a permanent part of the system. A change may be tested first and then implemented throughout the organization.
Information System (IS)
Refers to the information system of an organization, usually the computerized information system.
The list of essential process changes that will help lead to breakthrough improvement. Key changes are more focused and detailed than change concepts, but they are not specific to the local environment like change ideas.
The individuals in an organization, or organizations in an industry, who adopt change only after the majority are already utilizing the change idea.
A meeting or conference call during which participating organization teams meet and collaborate to learn new developments or key changes for a topic area. Teams leave these meetings/calls with new knowledge, skills, and materials that prepare them to make immediate changes in their organizations.
An electronic mailing list. When e-mail is addressed to a listserv mailing list, it is automatically broadcast to everyone on the list. The result is similar to a newsgroup or forum except that the messages are transmitted as e-mail and are available only to individuals on the list. See Electronic Mailing List.
A focused, reportable unit that will help a team monitor its progress toward achieving its aim. Most quality improvement efforts have a list of required key measures as well as additional key measures that may be helpful in achieving desired results. Improvement measures can be divided into three classifications: outcome, process, and balancing. Within these three classifications, measures may be clinical, operational, or financial:
Relates to how the system is performing on patient outcomes, e.g. the average A1c level for patients with diabetes.
Relates to how parts or steps of a system are working such as the number of asthma patients with a certain serverity that were last contacted.
Relates to how changes in one part of a system are affecting another part of the system, such as monitoring a reduction of hosptial lengths of stay should be balanced by measurement of readmission rates.
Model for Improvement (MI)
An approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the adoption of proven and effective changes. The model includes use of “rapid-cycle improvement” – successive cycles of planning, doing, studying, and acting (PDSA cycles).
National Committee for Quality Assurance (NCQA)
A private, not-for-profit organization, founded in 1990, dedicated to improving health care quality through accrediation, certification, distinction, recognition, and evaluation programs.
Patient-Centered Medical Home (PCMH)
A model of primary health care that puts the patient at the center of the model and also includes: access to care; comprehensive care; coordinated care; evidence-based care; payment structures that value primary care; quality care; safe care; systems-based approach to care; and team-based care.
As part of the Model for Improvement, a structured trial of change which includes four phases: plan, do, study, and act. The PDSA cycle will naturally lead to the “plan” component of a subsequent cycle.
Patient Electronic Care System (PECS)
A multi-disease clinical registry developed to support the expansion of the HDC. See Registry.
The initial site location for focused changes. After implementation and refinement, the process will be spread to additional site locations.
Population of Focus (POF)
A designated set of patients who will be tracked to determine whether changes have resulted in improvements. Ideal size for most chronic disease improvement initiatives is between 150-300 patients (this is a dynamic number and will fluctuate slightly from month to month). It is this sub-population that will then be the initial focus of the change in practice.
Quality Assurance (QA)
The American Society for Quality (ASQ) defines assurance of quality as the planned and systematic actitivies implemented in a system so that quality requirements for a product or service will be fulfilled. Assurance of quality is a set of preventive activities that are focused on processes.
Quality Improvement (QI)
QI is a formal approach to the analysis of performance and systematic efforts to improve it. There are various methods or models of QI such as total quality management (TQM), continuous quality improvement (CQI), Six Sigma, LEAN, and more. All QI models are aimed at improving performance. In health care, improving performance can result in a reduction of medical errors, morbidity and mortality, and improved quality of life for patients and communities.
A multi-disciplinary group of staff members from an organization that is balanced and representative of all departments in an organization, and empowered to carry-out QI activities.
The person in the organization who organizes the QI committee and assures that QI activities are being completed. The QI coordinator is a critical component of the QI committee who assures that tests of change are implemented, PDSA cycles are completed, data collection and measurement is carried-out, and evaluations are accomplished.
A document that provides a “roadmap” for moving an organization towards improved quality that describes the infrastructure to support the organization’s quality improvment program and/or activities. The QI plan should include at least the following components: organization purpose and mission; program scope; QI leadership; QI committee description and members; roles and responsibilities of the QI committee and leadership; QI goals and policies; QI resources; performance measurement; methods for improvement; data management; and evaluation methods.
Formal organization documents that define procedures and processes necesarry to support QI in the organization.
A set or database of records that contain individual patient information. The registry should provide the following: clinically useful and timely information, reminders and feedback for providers and patients, ability to identify relevant patient subgroups and support proactive care, and facilitation of individual patient care planning. “Registry size” refers to the count of patients represented in the list.
See Annotated Run Chart.
The intentional and methodical expansion of the number and type of people, units, or organizations using quality improvements. The theory and application comes from the literature on the concept of Diffusion of Innovation. In clinical qualilty improvement work, this expansion could be to other patients, providers, and sites.
A board that displays information about the progress of quality improvement work. The storyboard may be displayed at meetings as well as break rooms or patient rooms.
The ability to maintain the improved system of care. This implies that the changes implemented are no longer person-dependent, but are driven by the routine of the system. New procedures, staff roles, and staff responsibilities are documented in policies and procedures, job descriptions, and other documents.
The team member in the organization who has a strong understanding of the process to be improved and changes to be made. A technical expert may also provide expertise in process improvement, data collection and analysis, and team function.
A small-scale trial of a new approach or a new process. A test is designed to learn if the change results in improvement, and to fine-tune the change to fit the organization and patients. Tests are carried out using one or more PDSA cycles.