Principles of Healthcare Quality Management: Tools & Applications – Chapter 4

best practice
A method or technique that has consistently produced results superior to those achieved with other means.
Center for Medicare & Medicaid Services (CMS)
An agency responsible for administering the Medicare program, Medicaid program, State Children’s Health Insurance Program (SCHIP), and various healthcare standards.
clinical measures
Measures that are related to clinical performance.
Department of Health and Human Services (HHS)
An agency established to administer health-related services, particularly to communities that are unable to seek services themselves.
department of insurance
A unit of the state government that manages the activities of insurance companies conducting business in their state.
health policies
Authoritative decisions that come from the government in order to improve a certain outcome or control healthcare players’ actions.
hospital safety score
Score resulting from a survey conducted by the Leapfrog Group as its initiative to enhance the safety of hospital care.
The Joint Commission (TJC)
A non-profit organization that serves as a regulatory agency for quality assurance.
judicial decisions
A final decision made by the courts in cases in which laws and other regulations are unclear and clarification or interpretation is needed.
laws
Policies that are formulated and approved by legislators that are codified in the statutory language of specific pieces of enacted legislation.
Medicare Shared Savings Program
A program that rewards ACOs when they incur lower costs while meeting quality standards and satisfying patients and their health plans.
National Patient Safety Goals (NPSG)
A series of specific actions recommended by a panel of national experts to prevent medical errors, such as patient misidentification, miscommunication among caregivers, and surgery on the wrong body part.
National Quality Forum (NQF)
A nonprofit organization that enhances healthcare transformation by reviewing, endorsing, and recommending use of standardized healthcare performance measures.
National Quality Improvement Goals (NQIG)
Desirable goals for effectively treating patients with specifically identified conditions, such as children’s asthma, heart attack, heart failure, pneumonia, pregnancy and related conditions, and surgical care improvement.
NCQA accreditation standards
Measures that are required by NCQA during its accreditation process.
operational decisions and guidelines
Documents of practical application, which have less authority than rules and much less than healthcare laws.
rules and regulations
More detailed interpretations of healthcare laws, which are made in the executive branch of government by the organizations and agencies responsible for implementing laws and policies.
tracer methodology
A methodology that allows Joint Commission surveyors to evaluate the organization’s systems of providing care and services by using a patient’s record as a roadmap, moving through areas that individual experienced.