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Key Terms Chapter 3 Green

Activity of daily living (ADL) include bathing, dressing,eating,, toileting,walking, and so on ( also called custodial care)
acute care facility (ACF) a hospital that provides health care services to patients who have serious, sudden, or acute illnesses or injures and/ or who need certain surgeries
acute hospital classification is short-term with an average length of stay of 4-5 days and a total of less than 25 days
Administration for Children and Families (ACF) responsible for programs that provide services and assistance to needy children and families, including Temporary assistance to Needy Families (TANF), which is the new state-federal welfare program
Administration on aging (AoA) supports a nationwide aging network, providing services to the elderly to enable them to remain independent
adult day care provides care and supervision in a structured environment to seniors with physical or mental limitations
Agency for Healthcare Research and Quality (AHRQ) supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services
Agency for Toxic Substances and Disease Registry (ATSDR) works with states and other federal agencies to prevent exposure to hazardous substances from waste sites
Centers for Disease Control and Prevention (CDC) provides a system of health surveillance to monitor and prevent outbreak of diseases
Food and Drug Administration (FDA) assures the safety of foods and cosmetics, and the safety and efficiency of pharmaceuticals, biological products, and medical devices
Health Resources and Services Administration (HRSA) provides health services for medically under-served populations,works to build the health care workforce, maintains National Health Service Corps, oversees nation's organ transplantation system,works to decrease infant mortality and improve child health
Health Resources and Services Administration (HRSA) - Continued provides services to people with Aids through the Ryan White CARE Act Programs
Indian Health Services (IHS) supports a network of 37 hospitals, 60 health centers, 3 school health centers, 46 health stations, and 34 urban Indian health centers to provide services to nearly 1.5 million American Indians and Alaska Natives of 557 federally recognized tribes
National Institutes of Health (NIH) 17 separate institutes,the world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's disease, diabetes, arthritis, heart ailments, and AIDS
Substance Abuse and Mental Health Services Administration (SAMHSA) works to improve the quality and availability of substance abuse prevention, addition treatment, and mental health services
ancillary services diagnostic and therapeutic services provided to inpatients and outpatients ( Ex. laboratory, physical therapy)
assisted - living facility (ALF) a combination of housing and supportive services including personal care and household management for seniors ( Ex. bathing, meals)
Ambulatory surgery patients undergo certain procedures that can be performed on an outpatient basis, with the patient treated and released the same day. Length of stay is a max of 23 hrs, 59 minutes, and 59 seconds. If a longer stay is required they must be admitted as an impatient
ambulatory patients(outpatients) are treated and released the same day and do not stay overnight in the hospital. The maximum stay is 23 hrs, 59 minutes, and 59 seconds
emergency care patients treated for urgent problems(trauma) and are either released the same day or admitted overnight to the hospital as inpatients
inpatients stay overnight in the facility for 24 or more hours, and are provided with room and board and nursing services
newborn patients receive infant care upon birth, and if necessary they receive neonatal intensive care either within the hospital or as the result of transfer to another hospital
observation patients receive services furnished on a hospital's premises that are ordered by a physician or other authorized individual, (use of a bed,periodic monitoring by nursing or other staff,which are reasonable and necessary to evaluate an outpatient's condition
sub acute care provided in hospitals that provide specialized long-term acute care ( ex. chemotherapy, injury rehabilitation, ventilator support, wound care, and other types of health care services provided to seriously ill patients (less expensive than acute care)
ambulatory care ( outpatient care) allows patients to receive care in one day without the need for inpatient hospitalization
long-term care includes a range of nursing, social, and rehabilitative services for people who need ongoing assistance( typically longer than 30 days)
hospice care provides comprehensive medical and supportive social, emotional, and spiritual care to terminally ill patients and their families
palliative care comfort management
curative care therapeutic
diagnostic - related groups (DRGS) inpatient hospital cases classified into groups that are expected to consume similar hospital resources
single hospitals hospital is self-contained and not part of a larger organization
multi-hospital systems two or more hospitals owned, managed, or leased by a single organization: these may include acute, long-term , pediatric, rehabilitation , and/ or psychiatric care facilities
bed size ( bed count ) the total number of inpatient beds for which the facility is licensed by the state: must be equipped and staffed to care for these patient admissions
Critical access hospitals (CAHs) located more than 35 miles from any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents. Must provide emergency services 24 hrs a day and maintain no more than 15 inpatient beds
swing-bed criteria allow a a rural hospital to admit a non-acute care patient( can have 25 inpatient beds if no more than 15 are used at any one time for acute care)
general hospitals provide emergency care, perform general surgery, and admit patients for a range of problems from fractures to heart disease, based on licensing by state
specialty hospitals concentrate on a particular population of patients(children) or disease category( cancer)
rehabilitation hospitals(inpatient) admit patients who are diagnosed with trauma ( car accident)or disease( stroke) and need to learn how to function
behavioral health care hospitals specialize in treating individuals with mental health diagnoses
short-term(acute) hospital classification average length of stay of 4-5 days and a total of less than 25 days
long-term hospital classification average length of stay greater than 25 days
Hospitalists physicians who spend most of their time in a hospital setting admitting patients to their inpatient services from local primary care providers
long-term care hospitals (LTCH) defined in Medicare law as hospitals that have an average inpatient length of stay greater than 25 days
durable medical equipment (DME) includes canes,crutches,Iv supplies,hospital beds,ostomy supplies,oxygen, prostheses, walkers, wheelchairs
home care allows people who are seriously ill or dying to remain at home and receive treatment from nurses, social workers, therapists, and other licensed health care professionals who provide skilled care int he home
skilled care includes services that are ordered by a physician and provided under the supervision of a registered nurse, or physical, occupational,or speech therapist
personal care and support services provides assistance in performing daily living activities like bathing, dressing, grooming, going to the toilet, mealtime assistance, travel training, and accessing recreation activities
home infusion care provided by home health agencies when intravenous administration of medication is medically appropriate for the patient's condition, and treatment is given in the home instead of an inpatient hospital basis
chemotherapy intravenous administration of chemical agents that have specific and toxic effects upon a disease- causing cell or organism
drug therapy intravenous administration of other drugs including antibiotics, antivirals, and so on
hydration therapy intravenous administration of fluids, electrolytes, and other additives
pain management intravenous administration of narcotics and other drugs designed to relieve pain
total parenteral nutrition (TPN) administration of nutritional substances by peripheral or central intravenous infusion to patients who are either already malnourished or have the potential for developing malnutrition
Alzheimer's treatment facilities have many of the same characteristics as assisted- living facilities, but there is more extensive monitoring of residents and day-to-day care
ventilator breathing machine
Continuing Care Retirement Communities (CCRC) provide different levels of care based on the resident's needs from independent living apartments to skilled nursing care in an affiliated nursing facility
intermediate care facility (ICF) provides developmentally disabled people with medical care and supervision, nursing services, occupational and physical therapies, activity programs,educational and recreational services, and psychological services
federal certification measures the ability of health care facilities to deliver care that is safe and adequate, in accordance with federal law and regulations
long-term care hospital (LTCH) defined in Medicare law as a hospital that has an average inpatient length of stay that is greater than 25 days
residential care facility (RCF) provides non medical custodial care, which can be provided in a single family residence, retirement residence,or in any appropriate care facility including a nursing home( not allowed to provide skilled services Ex. injections,colostomy care)
skilled nursing facility (SNF) nursing facility (NS) provides medically necessary care to inpatients on a daily basis that is performed by, or under the supervision of skilled medical personnel
managed care term is increasingly being use to refer to preferred provider organizations (PPO's)and some forms of indemnity coverage that incorporate utilization management activities
utilization management controls health care costs and the quality of health care by reviewing cases for appropriateness and medical necessity
pre-admission certification (PAC) a form of utilization management that involves the review for medical necessity of inpatient care prior to inpatient admission
medical necessity requires the documentation of services or supplies that are proper and needed for the diagnosis or treatment of a medical condition: are provided for these purposes, meet the standards of good medical practice in local area & are not for convenience
correctional facilities provide inmates with a secure housing environment that also offers vocational and educational advancement
Bureau of Prisons (BOP) provides necessary medical, dental, and mental health services to inmates by a professional staff and consistent with acceptable community standards (provide inmate ambulatory care )
federal medical centers (FMCs) provide inmates with major medical care
National Commission on Correctional Health Care (NCCHC) established in 1970's to provide an external peer review process for correctional institutions that wish to meet its nationally accepted standards for health services
military health system (MHS) administers health care for active members of the uniformed services and their dependents as provided by military treatment facilities and networks of civilian health care professionals
military treatment facility (MTF) a clinic or hospital located on a United States military base
Military Medical Support Office(MMSO) coordinates civilian health care services when MTF services are unavailable
Veterans Health Administration (VHA) an agency in the Department of Veterans Affairs, provides medical, surgical, and rehabilitative care to veterans of the armed services
Veterans Integrated Service Networks (VISN) administer and provide health care services at VA medical centers and community- based outpatient clinics
Public Health Services (PHS) Uniformed Service of the Department of Health and Human Services. Leadership is provided by U>S> Surgeon General . Provides highly trained and mobile professionals who carry out programs to promote nation's health, understand & prevent disease
Public Health Services (PHS) continued injury , assure safe effective drugs and medical devices, deliver health care services to federal beneficiaries and furnish health expertise in time of war or other national/ international emergencies
ambulatory infusion center (AIC) freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients
ambulatory surgical center (ASC) surgery is preformed on an outpatient basis, patients arrive on the day of the procedure, undergo surgery in operating room and recover under the care of nursing staff
cafeteria plan provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan: also called triple option plan
chemical dependency program provides 24 hr. medically directed evaluation and withdrawal management in an acute care inpatient setting. Usually includes detoxification and withdrawal management, chemical dependency/substance abuse assessment and therapy
clinical laboratory performs testing in microbiology, clinical chemistry , and toxicology: directed by a pathologist and testing is performed by certified,professional technologists and technicians
clinic outpatient hospital ambulatory care patient who receives scheduled diagnostic and therapeutic care
closed- panel HMO includes group and staff models that provide services at HMO-owned health centers or satellite clinics, or by physicians who belong to a specially formed medical group that serves the HMO
co-payment fixed amount a subscriber must pay when seeking health care services
crisis services provides short term crisis (usually less than 15 days) intervention and treatment, patients have 24 hr. supervision
day treatment program intensive treatment program provided to patients who live in the community but come to the facility up to five days a week
dementia care facilities long term care facilities that specialize in the care of patients diagnosed with dementia
developmentally disabled/ mentally retarded facilities sometimes categorized as (ICF) intermediate care facility, provide residential care, day programming;including academic training,clinical & technical assistance,health care services, & diagnosis & evaluation of individuals with developmental disabilities
direct contact model HMO individual physicians in the community deliver contracted health care services to subscribers
emergency care center immediate care is provided by an on duty physician(usually salaried), center is usually owned by private corporations in states where permitted or non-profit facilities: also called urgent care center
emergency care patient one treated for urgent problems and either released the same day or admitted to the hospital as an inpatient
Exclusive Provider Organization (EPO) provides benefits to subscribers who receive health care services from network providers
family practitioners provides care for the entire family and focuses on general medicine, obstetrics,pediatrics,and geriatrics
Family Support Services services provided to assist families in caring for the patient
flexible benefit plan provides subscribers and employees with a choice of HMO,PPO,or traditional health insurance plan: also called cafeteria plan
group model HMO participating physicians who are members of an independent multispecialty group providing health care services, physicians either contract with the HMO or they are owned or managed by the HMO
Group Practice Without Walls (GPWW) managed care contract in which physicians maintain their own offices and share services to plan members
Health Maintenance Organization (HMO) an alternative to traditional health insurance coverage, provides comprehensive health care services to members on a prepaid basis
heart and vascular center provides ambulatory cardiovascular services to include diagnosis and treatment, disease prevention, research,education, and cardiac rehabilitation
hospital- owned physician practice practices that are at least partially owned by the hospital, and physicians participate in a compensation plan provided by the hospital
imaging center freestanding facility that provides radio-graphic and other imaging services to ambulatory patients, some centers also provide training and participate in national research projects
Independent Practice Association(IPA) physicians who remain in their independent office settings but provide contracted health care services to subscribers, negotiates the HMO contract and manages the capitation payment,also called Individual practice association
Individual Practice Association (IPA) physicians who remain in their independent office settings but provide contracted health care services to subscribers, negotiates the HMO contract and manages the capitation payment,also called independent practice association
Industrial health clinic located in a business setting, the emphasis is on employee health and safety
infusion center freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients, supervised by a licensed health care professional; also called ambulatory infusion center(AIC)
inpatients those who remain overnight in a facility for 24 or more hrs. and are provided with room and board and nursing services
Integrated Delivery System(IDS) organization of affiliated provider sites that offer joint health care services to subscribers.Sites include ambulatory surgical centers,hospitals,physicians groups.
Integrated Provider Organization (IPO) manages health care services provided by hospitals, physicians, and other health care organizations
intensive case management specially trained individuals coordinate and/or provide mental health,financial, legal, and medical services to help the patient live successfully at home and in the community
Management Service Organization (MSO) provides practice management services,including administrative and support services, to individual physician practices
medical foundation nonprofit organization that contracts with and acquires the clinical and business assets of physician practices
multi- specialty group physician practices offer various types of medical specialty care in one organization, and they may be located in more than one location
National Commission on Correctional Health (NCCHC) provides an external peer review process for correctional institutions that wish to meet its nationally accepted Standards for Health Services
neighborhood health center health care is provided to economically disadvantaged people, and treatment is family-centered b/c illness may result indirectly from crowded living conditions,unsanitary facilities, and other socioeconomic factors
network model HMO two or more physician multi-specialty group practices provide contracted health care services to subscribers
network providers physicians and health care facilities under contract to the managed care plan
open - panel HMO includes direct contract,individual practice association,and network models;physicians are not employees of the HMO and they do not belong to a specially formed medical group that serves the HMO
outpatient care allows patients to receive care in one day without the need for inpatient hospitalization;also called ambulatory care
outpatient clinic patients receive follow-up mental health care,and visits are usually under one hour. The number of visits per week depends on the patients needs
outpatients patients who are treated and released the same day and do not stay overnight in the hospital. The maximum stay is 23 hrs, 59 minutes, and 59 seconds: also called ambulatory patients
pain management center specializes in treatment of acute and chronic pain syndromes using proven medications and procedures.
partial hospitalization program program for hospital patients who regularly use the hospital facilities for a substantial number of either daytime or nighttime hours
pediatricians provides comprehensive services for infants,children,and adolescents
Physician- Hospital Organization (PHO) managed care contracts are negotiated by hospital(s) and physician groups: physicians maintain their own practices and provide services to plan members
Point - of - Service plan (POS) patients have the freedom to use an HMO panel of providers(co-payment is paid)or to self-refer to non-HMO providers(greater out0of-pocket expenses apply)
Preferred Provider Organization (PPO) network of physicians and hospitals join together to contract with third-party payers,employers,and other organizations to provide health care to subscribers for a discounted fee
public health department provides preventive medicine services such as well baby clinics,which include immunizations and routine checkups
referred outpatient hospital ambulatory car patient who receives diagnostic or therapeutic care b/c such care is unavailable in the primary care provider's office, follow-up is done at the primary care provider's office
rehabilitation facility(outpatient) provides occupational,physical,speech therapy to patients with orthopedic, work related, & sports related injuries, and various neurological & neuromuscular conditions
residential treatment facility seriously disturbed patients receive intensive and comprehensive psychiatric treatment on a long-term basis
respite care care is provided by specially trained individuals at a setting other than the patient's home to offer relief and rest to primary caregivers
satellite clinics ambulatory care centers that are established remotely from the hospital ,primary care is provided by an on duty physician (usually salaried)
single-specialty group physician practices single specialty practices that consist of two or more physicians who provide patients with one specific type of care
solo physician practices organizations that do not have physician partners or employment affiliations with other practice organizations
staff model health maintenance organization (HMO) similar to large multi-specialty group practices , it may be partially owned by physicians employees,with the physicians typically functioning as employees of either the physician group owning the practice or the insurer
student health center provides health care to full and part time students who become ill or injured
sub-acute care provided in hospitals that provide specialized long-term acute care such as chemotherapy,injury rehabilitation,ventilator support,wound care,and other types of health care services provided to seriously ill patients
subscribers individuals who pay health insurance premiums
Temporary Assistance to Needy Families (TANF) state -federal welfare program
therapeutic group home six to 10 individuals are provided with supervised housing that may be linked with a day treatment program
triple option plan provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan; also called cafeteria plan
urgent care center(emergency care center) immediate care is provided by an on duty physician (usually salaried), center is usually owned by private corporations in states where permitted or non-profit facilites
Created by: ckoontz7771