Glossary of Quality Terms

Accreditation

Accreditation is a process in which a healthcare organization undergoes an examination of its policies, procedures and performance by an external private sector organization ("accrediting body") to ensure that it is meeting predetermined criteria. It usually involves both on- and off-site surveys.

American Hospital Association (AHA)

The AHA is the national organization that represents and serves all types of hospitals, healthcare networks, and their patients and communities. AHA takes part in national health policy development, legislative and regulatory debates, and legal matters. AHA provides education for healthcare leaders and is a source of information on healthcare issues and trends.

Antibiotic

Medicine used to fight bacteria in the body.

Beta Blocker

A type of medicine that is used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. Beta blockers relieve the stress on the heart by slowing the heart rate and reducing the force with which the heart muscles contract to pump blood. They also help keep blood vessels from constricting in the heart, brain, and body.

Cancer Stages

Staging describes the extent or severity of an individual's cancer based on the extent of the original (primary) tumor and the extent of spread in the body.

• Stage 0 - Early cancer that is present only in the layer of cells in which it began.
• Stage I, Stage II, and Stage III - Higher numbers indicate more widespread disease greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs adjacent to the primary tumor.
• Stage IV - The cancer has spread to another organ.

Carcinoma

Cancer that begins in the skin or in tissues that line or cover body organs. For example, carcinoma can arise in the breast, colon, liver, lung, prostate, and stomach.

Centers for Medicare and Medicaid Services (CMS)

The Centers for Medicare and Medicaid Services are part of the federal government Department of Health and Human Services. Medicare and Medicaid account for a significant amount of healthcare insurance provided to many Americans. As part of receiving federal money, CMS requires that hospitals meet its Conditions of Participation which reinforce high quality and safety standards. CMS also has several Pay for Performance (P4P) programs which link reimbursement to hospital quality and safety performance.

Continuous Quality Improvement Collaboratives (CQI)

Henry Ford Health participates in many national, state, and local continuous quality improvement efforts, including those sponsored by the Michigan Hospital Association Quality and Keystone center, the federal Hospital Engagement Networks, many efforts sponsored by Blue Cross Blue Shield of Michigan, and other programs sponsored by healthcare societies such as the American College of Cardiology, the Society of Thoracic Surgery, and NSQIP, the national surgical improvement program. These collaboratives help us continuously improve our quality and safety.

Core Measures

Some quality and safety measures are considered “core” as defined by CMS. These measures are reported to CMS and included in the Pay for Performance measures. Core measures include processes to ensure high quality of care for stroke, obstetric care, surgical care and others. Past core measures have included Heart Failure, Heart Attack and Pneumonia. These measures are no longer reported to CMS, as performance as a nation has significantly improved.

Det Norske Veritas (DNV)

In addition to the Joint Commission, DNV (Det Norske Veritas), is another accreditation agency which ensures that hospitals meet the CMS requirements. In Henry Ford Health, both West Bloomfield and Wyandotte use DNV for accreditation.

Electronic Medical Record (EMR)

The electronic medical record (also known as EHR or electronic health record) is key to our continued improvements in quality and safety. Providers have access to patient data when and where it is needed. Orders and documents are clear and legible. Our ability to use and evaluate our performance through data analysis helps us understand our performance, and continuously improve. Henry Ford Health is rated a HIMSS 6 organization (near the top of information technology capabilities).

Evidence-Based

Evidence-based medicine aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).

Hospital Acquired Infections (HAI)

Infections sometimes occur while patients are hospitalized. Infections are closely evaluated, and much effort has been placed on reducing and eliminating these infections. Henry Ford Health has dramatically reduced catheter related blood stream infections (BSI) and Clostridium difficile (c. diff). We continue our efforts to reduce catheter associated urinary tract infections (CAUTI), surgical site infections (SSI) and resistant strains of a bacteria known as Staph aureus (MRSA). Infections are reported to the Centers of Disease Control (CDC) and included in the CMS Pay for Performance measures.

Inpatient Hospital Services

Services provided to patients admitted to a hospital that includes bed and board, nursing services, diagnostic or therapeutic services, and medical or surgical services.

Mortality

A fatal outcome or, in one word, death. A mortality rate is a death rate.

Patient Safety Indicators (PSI)

Patient Safety Indicators (PSI) are various complications which are defined by CMS as patient safety events. These include surgical accidental puncture and laceration, pneumothorax (puncture of lung), blood clots (VTE), and several other complications. These must all be reported to CMS and are included in the Pay for Performance measures.

Perioperative

Period shortly before, during and shortly after an operation.

Pneumonia

An inflammation of the lungs caused by a viral or bacterial infection. This fills your lungs with mucus and lowers the oxygen level in your blood. Symptoms can include fever, fatigue, difficulty breathing, chills, a "wet" cough, and chest pain.

Pneumonia (pneumococcal) Vaccination

Vaccine given to prevent pneumonia, estimated to protect against 80% of bacteria causing pneumonia.

Pressure Ulcer

A pressure ulcer (sometimes referred to as a bed sore) is an area of skin that breaks down when a patient stays in one position for too long without shifting their weight.

Process Improvement (PI)

Henry Ford Health is dedicated to continuously evaluating, monitoring and improving its quality through the use of many tools of process and performance improvement. Many of these tools were learned from industry, such as Lean, Total Quality Management, Six Sigma, and PDSA (plan/do/study/act).

Quality

Quality healthcare is how well a doctor, hospital, health plan, or other provider of healthcare, keeps its members healthy or treats them when they are sick. Good quality healthcare means doing the right thing at the right time, in the right way, for the right person and getting the best possible results.

Risk-Adjusted

To calculate the hospital death rates and rates of readmission, Medicare uses a complex statistical procedure. The rates are "risk-adjusted," meaning that the calculations take into account how sick patients were when they went in for their initial hospital stay. When rates are risk-adjusted, it means that hospitals that usually take care of sicker patients won't have a worse rate just because their patients were sicker when they arrived at the hospital. When rates are risk-adjusted, it helps make comparisons fair and meaningful.

Readmissions

Patients who are discharged from the hospital, sometimes return for illness that may or may not have been related to their first admission. Re-admissions to the hospital within 30 days of discharge are carefully monitored, and are tracked by CMS. These are included in the CMS Pay for Performance measures. Readmissions from all causes are carefully evaluated, and hospitals have developed many programs to improve the transition from hospital to home to prevent unnecessary readmissions.

Severity-Adjusted Mortality

A calculated rate of mortality (death rate), based on the severity of a morbid (diseased state, disability, or poor health due to any cause) condition. This data is used to determine appropriate reimbursement from Medicare.

The Joint Commission

An organization that evaluates and accredits healthcare organizations and programs in the United States. The Joint Commission is an independent, not-for-profit organization. The Joint Commission looks at how well a hospital treats patients and how good a hospital's staff and equipment are. A hospital is accredited by The Joint Commission if it meets certain quality standards. These checks are done at least every 3 years. Most hospitals take part in these accreditations.

Vein Thromboembolism (VTE)

A venous thromboembolism (VTE), also known as deep venous thrombosis (DVT) is a blood clot, which usually occurs in the leg. It could also occur in the arm, or elsewhere. When a blood clot breaks off and travels to the lung, this is called a Pulmonary Embolism (PE). VTE and PE can often be prevented, or treated, with medications known as blood thinners. (Heparin, Warfarin, other newer agents).

Ventilator Associated Events

Ventilator Associated Events (VAE) is a sub-type of hospital-acquired pneumonia (HAP) which occurs in people who are on mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours.