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Chap 3 - Key Terms

Health Care Settings - key terms

QuestionAnswer
activity of daily living (ADL) Bathing, dressing, eating, toileting, walking, and so on
acute care facility (ACF) Hospital that provides health care services to patients who have serious, sudden, or acute illnesses or injuries and/or who need certain surgeries.
acute hospital classification patients have an average LOS of 4-5 days and a total LOS of less than 25 days; also called short-term hospital classification.
Administration for Children and Families (ACF) DHHS programs that provide services and assistance to needy children and families, including Temporary Assistance to Needy Families (TANF)
Administration on Aging (AoA) DHHS program that 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) DHHS agency that supports research designed to improve the outcomes and quality of healthcare, reduce its costs, address patient safety and medical errors, and broaden access to effective services.
Agency for Toxic Substances and Disease Registry (ATSDR) DHHS agency that works with states and other federal agencies to prevent exposure to hazardous substances from waste sites.
Alzheimer's treatment facilities Long-term care facility that specializes in the care of patients diagnosed with Alzheimer's disease
ambulatory care Outpatient care that allows patients to receive care in one day without the need for inpatient hospitalization; also called outpatient care
ambulatory infusion center (AIC) freestanding center that dispenses and administers prescribed medications by continuous or intermittent infusion to ambulatory patients. Infusion is supervised by a licensed health care professional; also called infusion center.
ambulatory patients Patients who are treated & released the same day and do not stay overnight in the hospital; length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds; also called outpatients
ambulatory surgical center (ASC) surgery is performed on an outpatient basis at a free-standing ambulatory surgical center. pts arrive on day of procedure, undergo surgery in operating room, and recover under care of nursing staff
ambulatory surgery patient outpatient surgical patients who are treated & released the same day; length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds;if pts require longer stay they must be admitted to the facility as an inpatient.
ancillary services diagnostic and therapeutic services provided to inpatients and outpatients
assisted-living facility (ALF) combination of housing and supportive services including personal care and household management for seniors. Residents pay mthly rent & add'l fees for services they require
bed count Total number of inpatient beds for which the facility is lecensed by the state; also called bed size.
bed size Total number of inpatient beds for which the facility is lecensed by the state; also called bed count
behavioral health care hospital specializes in treating individuals with mental health diagnoses.
Bureau of Prisons (BOP) federal program that provides necessary medical, dental, and mental health services to inmates by a professional staff and consistent with acceptable community standards. consists of 82 institutions, each of which provides inmate ambulatory care.
cafeteria plan provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan; also called triple aoption plan.
capitation payment lump sum paid by the HMO to the provider to care for a group of subscribers.
Centers for Disease Control and Prevention (CDC) DHHS agency that provides a system of health surveillance to monitor and prevent the outbreak of diseases
chemical dependency program provides 24-hr medically directed evaluation and withdrawal management in an acute care inpatient setting. Treatment services usually include detoxification & withdrawl managment, chemical dependency/substance abuse assessment, & therapy.
chemotherapy intravenous administration of chemical agents that have specific and toxic effects upon a disease causing cell or organism.
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 clnics, or by physicians who belong to a specially formed medical group that serves the HMO.
Continuing Care Retirement Communities (CCRC) provides different levels of care based on the residents' needs from independent living apartments to skilled nursing care in an affiliated nursing facility.
copayment fixed amount oa subscriber must pay when seeking health care services.
correctional facilities provides inmates secure housing environment. Offers vocational/educational advancement,medical,dental,mental health to inmates. Standard of care imposed by court decisions,legislation,accepted correctional & health care standards,dept policies/procedures.
crisis services provides short-term (usually fewer than 15 days) crisis intervention and treatment; patients receive 24-hr-per-day supervision.
critical access hospital (CAH) located more than 35 miles form any other hospital or another CAH, or they are state certified as being a necessary provider of health care to area residents.
curative care therapeutic
day treatment program intensive treatment program provided to patients who live in the community but come to facility up to 5 days per week.
dementia care facilities long-term care facilities that specialize in the care of patients diagnosed with dementia.
developmentally disabled/mentally retarded facilities facilities provide residential care & day programming, includes academic training, clinical/technical assistance, health care services, diagnosis & evaluation of individuals with developmental disabilities. AKA intermediate care faciity (ICF)
diagnosis-related groups (DRGs) IP hosp cases classified into groups that are expected to consume similar hospital resources. Hosp IP's discared once acture phase of illness has passed, often transferred to other types of health care, such as OP care, SCF, Rehab, home health,etc.
direct contract model HMO individual physicaisns in community delive contracted health care services to subscribers
drug therapy intravenous administration of other drugs; antibiotics, antivirals, etc.
durable medical equipment (DME) canes, crutches, IV supplies, hospital beds, ostomy supplies, oxygen, prosteses, walkers, wheelchairs,etc
emergency care center immedicate care provided by an on-duty physician (usually salaried). Center is usually owned by private corp in states where permitted or non-profitfcailites, aka urgent care center.
emergency care patient one treated for urgent problems and either released the same day or admitted to the hospital as an IP.
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 prvided to assist families in caring for the patient.
federal certification measures ability of health care facilities to delive care that is safe and adequate, in accordance with federal law & regulation.
federal medical centers (FMCs) provide major medical care to federal correctional facility inmates.
flexible benefit plan provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan; also called triple aoption plan.
Food and Drug Administration (FDA) DHHS agency that assures the safety of foods and cosmetics, and the safety and efficacy of pharmaceuticals, biological products, and medical devices
general hospitals provide emergency care, perform general surgery, and admit patients for a arange of problems from fractures ato heart disease, based on licensing by the state.
group model HMO participanting physicians who are members of an independent multispeciality group providing health care services. physicans grps either contrat w/HMO or are owned or managed by 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) alternative to traditional health insurance coverage; provides comprehensive health care services to members on a prepaid basis.
Health Resources and Services Administration (HRSA) DHHS agency-provides health resources to medically underserved populations, builds health care workforce,maintain Nat'l Health Service Corps,oversees nation's organ transplants, decreases infant mortality,improve child health,provides svs to AIDS pts
heart and vascular center provides ambulatory cardiovascular services to include diagnosis a& treatment, disease prevention, research, education & cardiac rehab
home care allows seriously ill or dying people to remain at home & receive treatment from nurses, social workers, therapists, & other licensed health care professionals who provide skilled care in the home.
home infusion care provided by home health care agencies when intravenous administration of meds is medically appropriate for pts' condition, and treatment is administered at home instead of in an IP hospital basis
hospice care provides comprehensive medical and supportive social, emotional, & spiritual care to terminally ill patients and their families. Goal is palliative rather than curative.
hospitalists physicians who spend most of time in a hospital setting admitting pts to IP services from local primary care providers.
hospital-owned physician practice practices that are at least partially owned by hospital and physicians participate in comprensation plan provided by hospital.
hydration therapy intravenous administration of fluids, electrolytes and other additives.
imaging center freestanding facility that provides radiographic & 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 & manages the capitation payment; also called Individual Practice Association.
Indian Health Service (IHS) DHHS agency, supports newtork of 34 hospitals, 60 health centers, 3 school health centers, 46 health stations & 34 urban Indian health centers to provide services to nearly 1.5 million American Indiancs & Alaska Natives of 557 federally recognized tribes.
Individual Practice Association (IPA) physicians who remain in their independent office settings but provide contracted health care services to subscribers. Negotiates the HMO contract & 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. Infusion is supervised by a licensed health care professional; aka Ambulatory infusion center (AIC)
inpatients those who remain overnight in the facility for 24 or more hours and are proviced with room and board and nursing services.
Integrated Delivery System (IDS) organization of affiliated provider sites that offer joint health care services. ie: amb surg ctr, hosp, phys grp. AKA integrated srvc netwk, delivery system, vert. integrated plan, vert/horiz. integrated system, health deliv. netwk & acctable health plan
Integrated Provider Organization (IPO) manages health care services provied by hospitals, physicians, and other health care organizations.
intensive case management specially trained individuals coordinate and/or provide mental health, financials, legal, and medical services to help the pt live successfully at home & in community.
intermediate care facility (ICF) provides developmentally disabled peole with medical care and supervision, nursing services, occupational and physical therapies, activity programs, educational & recreational services & physychological services.
internal medicine physicians speicalizes in the care of adults
long-term care includes a range of nursing, socials, and rehabilitative services for people who need ongoing assistance, LOS typically average greater than 30 days.
long-term care hospital (LTCH) hospitals that have an average IP LOS greater than 25 days. hospitals typically provide extended medical & rehabilitative care for patients.
long-term hospital classification hospitals that have an average IP LOS greater than 25 days. hospitals typically provide extended medical & rehabilitative care for patients.
managed care prepaid health care sector, such as HMOs, which combined health care delivery w/ financing of health care svs; increasingly used to refer to preferred provider organizations (PPOs) & some forms of indemnity coverage that incorporate util. mgmt activities.
Management Service Organization (MSO) provides practice management services, including administrative and support services, to individual physician practices.
medical foundation nonprofit organization that contrats with and acquires the clinical and busines assets of physician practices
medical necessity requires doc of svs or supplies proper & needed for dx or tx of med. condition; provided for dx, direct care, and tx of a med. condition; meets good medical practice standards in local area; not mainly for convenience of physcian or health care facility.
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 Medical Support Office (MMSO) coordinates civilian health care services when military treatment facility (MTF) services are unavailable.
military treatment facility (MTF) clinic and/or hospital located on a U.S. military base.
multi-hospital systems category of hospitals where 2 or more hosps are owned, managed, or leased by a single organization; may include acute, long-term, pediatric, rehab and/or psychiatric care facilities.
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 Care (NCCHC) provides an external peer review process for correctional institutions that wish to meet its nationally accepted Standards for Health Services.
National Institues of Health (NIH) DHHS research ctr, with 17 separate institutes, world's premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer's dz, diabetes, arthritis, heart ailments & AIDS.
neighborhood health center health care proviced to economically disadvantaged people, and tx is family-centered. Illnesses from crowded living conditions, unsanitary facilities, other socioeconomic factors. Phys, nurse and social worker provides continuity of care to families.
network model HMO 2 or more physician multi-specialty grp practices provide contracted health care services to subscribers
network providers physicians and health care facilities under contract to the managed care plan.
newborn patients those who receive infant care upon birth, and if necessary they receive neonatal intensive care either w/in hosp or as result of transfer to another hospital.
nursing facility (NF) provides medically necessary care to IPs on a daily basis that is performed by, or under supervision of, skilled medical personnel. SNF's provide IV therapy, rehab, wound care. AKA Skilled Nursing Facility (SNF)
observation patients receives services furnished on hosp premises that are ordered by physician or other authorized individual, includes use of bed, periodic monitoring by nursing or other staff, reasonable and necess. evaluate on OP's condition or need for possible IP.
open-panel HMO includes direct contract, individual practice assc, and network models; physicians are not employees of HMO and they do not belong to specially formed medical grp that serves the HMO.
outpatient care Outpatient care that allows patients to receive care in one day without the need for inpatient hospitalization; also called ambulatory care
outpatient clinic hospital ambulatory care patient who receives scheduled diagnostic and therapeutic care.
outpatients Patients who are treated & released the same day and do not stay overnight in the hospital; length of stay is a maximum of 23 hours, 59 minutes, and 59 seconds; also called ambulatory patients
pain management intravenous administration of narcotics and other drugs designed to relieve pain.
pain management center specializes in tx of acute & chronic pain syndromes using proven meds and procedures. Multidisciplinary approach involving participating specialists: psysiatrists, psychiatrists, neurologist, neurosurgeons, internists & physical/occupational therapists.
palliative care comfort management
partial hospitalization program program for hospital patients who regularly use the hospital facilities for a substantial number of either daytime or nighttime hours.
pediatricians provide comprehensive services for infants, children and adolescents
personal care and support services provide assistance in performing daily living activities, such as bathing, dressing, grooming, going to the toilet, mealtime assistance, travel training, and accessing recreation services.
Physician-Hospital Organization (PHO) managed care contracts are negotiated by hospital(s) and physician grps; physicians maintain their own practices and provide services to plan members.
Point-of-Service plan (POS) pts have the freedom to use an HMO panel of providers (for which a copayment is paid) or to self-refer to non-HMO providers (for which great out-of-pocket expenses apply).
preadmission certification (PAC) form of utilization management that involves the review for medical necessity of IP care prior to IP admission.
Preferred Provider Organization (PPO) Network of physicians and hospitals join together to contract with 3rd party payers, employers and other organizations to provide health care to subscribers for a discounted fee.
primary care center offers adult and family care medicine in internal medicine, pediatrics and family practice.
Public Health Service (PHS) Uniformed Svs of DHHS. Leadership prov'd by US Surg. General. Prov's highly trained/mobile hlth profess. promote nation's health, understand &prevent dz/injury, assure safe&effective drugs/med devices, hlth svs to fed.benefic., war or (inter)nat'l emerg.
public health department provides preventive medicine services such as well baby clinics, which include immunizations and routine checkups.
referred outpatient hosp ambulatory care pt who receives diagnostic or therapeutic care because such care is unavailable in the primary care provider's office. Follow-up is done at primary care providers office
rehabilitation facility (outpatient) provides occupations, physical, and speech therapy to pts with orthopedic, work-related,sports-relatedinjuries and various neurological and neuromuscular conditions. treated and released on same day.
rehabilitation hospital (inpatient) admits patients who are diagnosed with trauma or disease and who need to learn how to function.
residential care facility (RCF) provides non-medical custodial care, which can be provided in a single family residence, a retirement residence, or in any appropriate care facility including a nursing home.
residential treatment facility seriously disturbed patients receive intensive and comprehensive psychiatric treatment on a long-term basis.
respite care care 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 established remotely from the hospital. Primary care is provided by an on-duty physician (usually salaried).
short-term (acute) hospital classification patients have an average LOS of 4-5 days and a total LOS of less than 25 days; also called acute hospital classification
single hospitals category of hospitals that are self-contained and not party of a larger organization.
single-specialty group physician practices single speciality practices that consist of 2 or more physicians who provide pts with 1 specific type of care.
skilled care includes services that are orderd by a physician and provided under the supervision of a registered nurse, or physicial, occpational, or speech therapist.
skilled nursing facility (SNF) provides medically necessary care to IPs on a daily basis that is performed by, or under supervision of, skilled medical personnel. SNF's provide IV therapy, rehab, wound care. AKA Nursing Facility (NF)
solo physician practices organizations that do not have physician partners or employment affiliations with other practice organizations.
specialty hospitals concentrates on a particular population of patients or disease.
staff model health maintenance organization (HMO) similar to multi-spec grp practices, it may be partially owned by physician employees, w/physicians typically functioning as employees of either the phys grp owning the practice or the insurer. Most phys in this type of HMO are salaried
student health center provides health care to full-and part-time students who become ill or injured.
subacute care provided in hospitals that provide specialized long-term acutre care such as chemotherapy, injury rehabilitation, ventilator support, wound care, & other types of healthcare services provided to seriously ill patients.
subscribers individuals who pay health insurance premiums.
Substance Abuse and Mental Health Services Administration (SAMHSA) DHHS agency that works to improve the quality and availability of substance abuse prevention, addiction treatment, and mental health services.
swing bed allows a rural hospital to admit a nonacute care patient.
Temporary Assistance to Needy Families (TANF) state federal welfare program
therapeutic group home 6 to 10 individuals are provided with supervised housing that may be linked with a day treatment program.
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.
triple option plan provides subscribers and employees with a choice of HMO, PPO, or traditional health insurance plan; also called cafeteria plan or flexible benefit plan.
urgent care center (emergency care center) immedicate care provided by an on-duty physician (usually salaried). Center is usually owned by private corp in states where permitted or non-profit facilites.
utilization management controls health care costs and quality of health care by reviewing cases for appropriateness and medical necessity
ventilator breathing machine
Veterans Health Administration (VHA) agency in Dept of Verterans Affairs that provides medical, surgical, and rehabilitative care to veterans of the armed services.
Veterans Integrated Service Network (VISN) Administers and provides health care services at VA Medical Centers (VAMCs) and community-bases OP clinics.
Created by: Karen Lineberger