Welcome to CHSRA's Glossary. Learn definitions to new words and phrases quickly. Just click on the first letter for the term that you're looking for.

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Abbreviated Standard Survey - An on-site Federal survey that focuses on specific complaints or specific provider issues related to change of provider ownership, management or Director of Nursing. The abbreviated survey does not cover all the aspects contained in the standard survey, but rather concentrates on a particular area(s) of concern. An abbreviated standard survey may be conducted to substantiate a complaint.

Abuse - Willful intent to cause harm. Abuse may be resident (patient) to resident (patient) or staff to resident (patient) harm.

Accreditation - Recognition that a provider meets standards set by a national accrediting organization such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Active Treatment - An ongoing organized effort to help each resident (patient) maintain their developmental capacity through their regular participation, according to an individualized plan, in a program of activities designed to enable the resident (patient) to attain or maintain the optimal physical, social, intellectual, and vocational levels of functioning.

Activities of Daily Living (ADLs) - Individual self-performance skills needed in everyday life such as ambulation/locomotion, eating, toileting, grooming/personal hygiene, and bathing.

Activity Therapist (AT) - An allied health professional trained to develop and provide leisure time activities for facility residents (patients).

Administer - The direct application of a vaccine or a prescribed drug or device, whether by injection, ingestion or any other means, to the body of a resident (patient).

Advance Directive - Written instructions from residents (patients) about the management and provision of care if they become incapacitated (e.g., living wills, do not resuscitate orders, durable power of attorney for healthcare).

Adverse Drug Reaction (ADR) - Any unintended response to a drug which is injurious or harmful to health and which occurs at normal doses.

Ambulatory - Able to walk with or without difficulty or help.

Annual Assessment - An annual assessment of a resident's (patient's) physical, mental, emotional, cognitive, and functional status.

Antianxiety Medication - Psychoactive medications given to reduce anxiety (e.g., Ativan, Valium, Xanax).

Anticholinergic Side Effects - Dry eyes, dry mouth, blurred vision, constipation, urinary retention, behavior changes, loss of cognitive function.

Antidepressant Medication - Psychoactive medications given to relieve depression (e.g., Celexa, Paxil, Prozac, Zoloft)

Antipsychotic Medication - Psychoactive medications given to reduce or control psychotic (withdrawal from reality) symptoms (e.g., Haldol, Prolixin, Risperdal, Zyprexa, and Seroquel).

Area of Rescue Assistance (ARA) - A room or stairwell landing used for safe refuge in a fire or other emergency by residents (patients) who are unable to negotiate stairs.

Assessment - An organized approach to taking stock of all information about residents (patients) to understand their physical, functional, medical, emotional, and social limitations and strengths. Standardized assessment tools are used in Medicare certified skilled nursing facilities and Medicaid nursing facilities (Minimum Data Set - MDS) and home health agencies (Outcome and Assessment Information Set - OASIS). Assessment types and schedules are available in CMS' Long Term Care Resident Assessment Instrument User's Manual and Outcome and Assessment Information Set Implementation Manual.

Assistant Director of Nursing (ADON) - A registered nurse who acts as the assistant to the Director of a facility's nursing services.

Assisted Living - A combination of housing, personalized supportive services and health care designed to meet the needs of those who need help with activities of daily living. Assisted Living residences may be freestanding or part of other residential options, such as independent living or nursing facilities. Licensing regulations vary from state to state.

Avoidable Decline - Reduction or loss of a resident's (patient's) physical, mental, emotional, cognitive, or functional well being attributable to actions or lack of actions by a facility.

Bedhold - A period of time during which a resident (patient) may return from hospitalization or therapeutic leave and resume residence in a facility. Facilities must provide residents (patients) and their guardians notice of their bedhold policies which must be in accordance with State and Federal laws.

Bedsore - See Pressure Sore/Ulcer.

Behavioral Intervention - Non-drug interventions used to change the resident's (patient's) behavior or environment to lessen or accommodate the resident's (patient's) behavioral symptoms.

Benign Senescent Forgetfulness - Age-related memory loss, which results from the slowing of neural processes with age.

Call System - A system to allow residents (patients) to communicate with a nurses' station from their rooms and from toilet and bathing facilities.

Capacity (Facility) - The maximum number of residents (patients) and other persons who may reside in the facility at any time under the terms of the facility license.

Care Plan - A plan designed to meet all of a 'resident's (patient's) identified physical, mental, emotional, cognitive, and functional needs. The care plan is generally the result of assessment and collaboration by an interdisciplinary team of provider staff. (Also known as the Plan of Care.)

Case Mix - A system that uses resident (patient) attributes (e.g., functional status in activities of daily living or cognitive ability) to classify residents (patients) for purposes such as reimbursement.

Center for Health Systems Research and Analysis (CHSRA) - An interdisciplinary research center in the College of Engineering at the University of Wisconsin-Madison. CHSRA conducts research, expanding and applying decision theory, measurement and evaluation techniques to measure performance and improve health systems. CHSRA developed and validated the MDS-based national quality indicators used in all Medicare and Medicaid certified nursing facilities.

Centers for Medicare & Medicaid Services (CMS) - Federal agency responsible for administering the Federal Medicare and Medicaid programs. CMS headquarters is located in Baltimore.

Certification - Approval of a provider to participate and receive payment from the Medicare and/or Medicaid programs. In some States, a system for determining if various individual healthcare professionals are qualified.

Certified Home Health Aide - A home health aide who has completed required State training and competency testing in the skills needed to work as a nurse aide.

Certified Medication Assistant (CMA) - Non-licensed personnel who are authorized to administer medications, under the supervision of licensed personnel (e.g., an RN), based on completion and testing in a State approved medication administration course.

Certified Nurse Aide (CNA) - A nurse aide who has completed required State training and competency testing in the skills needed to work as a nurse aide.

Charge Nurse - The nurse in charge or supervising a particular part of a facility for a given time shift.

Chemical Restraint - A psychoactive drug used by a facility for discipline or convenience and not for medical treatment.

Chronic Care - Care for residents (patients) who enter a nursing facility typically because they have chronic illnesses that require more assistance than they have available in their own home. These residents (patients) tend to remain in the facility for several months to years.

CHSRA Standard Report Set - This is a set of reports similar to what was previously sent out quarterly in the mail from CHSRA. The standard Report Set is available to all users of the ePIP system. While it provides a convenient way to request a group of reports like CHSRA previously mailed, it likely contains more than you would prefer to review if you request reports frequently. Look into Report Sets as a way to customize a series of reports for your facilities needs.

Civil Money Penalty (CMP) - A Federal fine imposed on facilities for noncompliance (see Enforcement Grid for levels of CMPs imposed).

Clinical Contraindication to a Psychoactive Dose Reduction - The resident (patient) has a specific condition and a history of recurrent psychotic symptoms which have been stabilized with a drug; or there have been two gradual dose reductions attempted in one year that resulted in the return of symptoms; or the resident's (patient's) physician provides in the clinical record a diagnosis, a risk/benefit analysis, and a conclusion why this treatment is necessary.

Clinical Links - For CHSRA QIs, a mapping of quality indicators that are clinically related to each other and should be considered when investigating care problems within a particular domain of care. (See Table below.)

Clinical Links among Domains and Chronic QI/QMs

Closed Record - The complete record of a resident (patient) that has died or been discharged by a provider.

Comparison Group - A group of facilities used to calculate comparison group percentages. By default, this is set to all facilities in the project that submit MDS data to CHSRA. Facilities that are part of our Oryx initiative also have the ability to select a Oryx facilities comparison group for its reports. Facilities located in Wisconsin also have the ability to select Wisconsin facilities participating in ePIP as their comparison group.

Complaint Investigation - An on-site investigation of specific allegations of noncompliance of a provider with Federal or State requirements.

Consultant Pharmacist - Pharmacist who is contracted by the nursing home to do drug regimen reviews and provide other services.

Continence - The ability to self-regulate bladder and bowel elimination.

Control Chart - Available only to ORYX members on the ePIP system, the Control Chart provides information about your facility's percentage compared to the ORYX comparison group, including:

• Facility QI percentage
• ORYX comparison group percentage
• Chart of 3 standard deviations (SDs) above and 3 SDs below the comparison group percentage

Controlled Substance - A drug, substance or immediate precursor included in schedules I to V of the Controlled Substance Act (e.g., morphine, acetaminophen with codeine, oxycodone).

Covariant - Changing with another variable: exhibiting a tendency to change in conjunction with another statistical variable.

Decubitus Ulcer - See Pressure Sore/Ulcer.

Deficiency - See Statement of Deficiency.

Delirium - An acute or sudden state of confusion. It is not the same as dementia or senility, which is an irreversible gradual chronic change. Many individuals with dementia can also get delirium. This often results in a significant sudden change in their confusion or function. Delirium is an urgent medical condition, not a psychiatric problem.

Dementia - Characterized by cognitive decline that occurs with a normal state of consciousness and in the absence of other acute or sub-acute disorders that may cause reversible cognitive decline (e.g. delirium, depression). It must be differentiated from Benign Senescent Forgetfulness (i.e., age-related memory loss).

Denial of Payment for New Admissions - A Federal penalty that must be imposed when a facility is not in substantial compliance within 3 months after being found out of compliance. Denial of payment and State Monitoring must be imposed when a facility has been found to have provided substandard quality of care on three consecutive standard surveys.

Developmental Disability (DD) - A severe chronic disability that has its origin in childhood and results in limitations in such areas as language, self-care, mobility, learning, economic self-sufficiency and independent living. Federal definitions define childhood as occurring before age 22; some states use other definitions. The federal definition includes both mental and physical impairments; states may differ in whether physical impairments in the absence of mental impairment is defined as a developmental disability. The specific definition used in each situation will affect the supports available to an individual.

Diagnosis - The identification of a disease from its signs and symptoms.

Dialysis - A mechanical process used to filter impurities from blood in response to renal (kidney) disease.

Director of Nursing (DON) - A registered nurse responsible for supervising the activities, functions, and training of nursing personnel.

Director of Nursing Services (DNS) - See Director of Nursing.

Discharge Planner - A person responsible for the assessment, referral, and discharge planning of a resident (patient).

Dispense - To deliver a prescribed drug to an ultimate user, including the compounding, packaging, and labeling necessary to prepare the prescribed drug.

Distinct Part - A Medicare or Medicaid certified component of a facility that is a separately sub-administered unit rendering a distinctive form of care in a separate building, floor, wing, ward, or a discrete part of one of these.

Division - This is a feature that is only available to ePIP clients that belong to a larger corporation. A Division is a unique group of facilities within your corporation that has been defined as part of a Classification. Divisions are mutually exclusive within each classification. Once a Division has been created, it can be set a Report Set parameter when requesting reports.

Doctor of Osteopathy (DO) - A physician licensed by state law to practice osteopathic medicine.

Domain - see QI Domain.

Drug - Any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease or other conditions in persons. Any substance other than a device or food intended to affect the structure or any function of the body of persons.

Drug Irregularity - A drug that is given without a medical reason; in an excessive or inadequate dose or duration of therapy; where side effects indicate that a dose modification or drug discontinuation is indicated, or inadequate monitoring for effect or manufacturer's recommendations for laboratory monitoring. This therapy results in potential negative outcome or is not achieving the stated objectives of the prescriber. The consulting pharmacist should address this potential drug therapy problem at the time of their drug regimen review.

Drug Regimen Review (DRR) - The review of drugs being used by a resident (patient) to determine effect and potential for harmful effects.

Drug Utilization Review (DUR) - The study of drug use patterns in a facility.

Enforcement Grid - A table developed by the Center for Medicare and Medicaid Services that defines severity and scope of Federal deficiencies and indicates whether plans of correction and remedies are necessary (see Grid below).

Federal Enforcement Grid (Nursing Homes)

Substandard quality of care is any deficiency in 42 CFR 483.13 - Resident Behavior and Facility Practice, 42 CFR 483.15 - Quality of Life or 42 CFR 483.25 - Quality of Care that constitutes immediate jeopardy to resident (patient) health or safety; or a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm that is not immediate jeopardy, with no actual harm.

Substantial compliance

Remedy Categories

Extended Survey - A Federal survey conducted within 14 days of a finding of substandard care during a standard Federal survey (see also Standard Survey).

ePIP - ePIP is the electronic version of CHSRA's Provider Initiative Project (PIP)/ORYX initiative. It allows members of the PIP/ORYX initiative to submit MDS data electronically to CHSRA for analysis, and to view, print or download QI reports based on the data submitted. ePIP also provides members with many new features including the ability to run specialized reports and Report Sets, as well as access to a great deal of QI related information.

Extrapyramidal Symptoms (EPS) - Abnormal movements of the mouth or tongue, pill rolling, tremors, rigid movements, mask-like face, constant movement of legs or body, tics, blinking, pacing, eyes rolled up, drooling.

F Tags - Data tags used to identify specific Federal nursing home regulations in the OSCAR data system (see also OSCAR).

Facility - General term used for any type of nursing home or intermediate care facility for the mentally retarded.

Facility Admission Profile (FAP) - The proportion of residents (patients) who have a given condition (e.g., pressure ulcer) upon admission to a facility. The FAP reflects the facility's resident (patient) population admitted over a 12-month period and is intended to capture the admitting characteristics of individual facilities. The FAP is used as a form of risk adjustment for some QMs.

Fine - See Forfeiture.

Flag - QIs flag when they reach the threshold or a set point at which the likelihood of a problem is sufficient to warrant further investigation. A QI will flag if it is ranked at the 90th percentile or above. In the case of sentinel health events, if even one resident is in the numerator, the QI will flag. It should be noted that CMS uses the 75th percentile as its threshold for LTC surveys.

The QIs are not measures of quality, therefore, if your facility flags on a Quality Indicator, it only means that it may be a potential problem and is something that probably should recieve additional review.

Follow-up Visit - See Post-Survey Revisit.

Forfeiture - State imposed fine for nursing home noncompliance with State licensure statutes or regulations (see also Civil Money Penalty).

G Tags - Data tags used to identify specific Federal home health agency regulations in the OSCAR data system (see also OSCAR).

Gait - How a person walks.

Guardian - Legal representative, appointed by a court, to make decisions for a person not competent to make their own decisions. Generally resident (patient) guardians have all of the legal rights normally granted to competent residents (patients).

Harm - Negative effect that has occurred to a resident (patient), infringement of a 'resident's (patient's) rights, or compromising of a 'resident's (patient's) ability to meet their highest practicable level of physical, mental, or psychosocial well being.

Health Insurance Portability and Accountability Act of 1996 (HIPAA) - A Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA gives HHS the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, the Kassebaum-Kennedy Bill, K2, or Public Law 104-191.

Home Health Agency - A public agency or private organization that is primarily engaged in providing skilled nursing services and other therapeutic services to individuals in his or her own home.

Hospice Care - Supportive care provided to terminally ill patients and their families in the final 6 months (Medicare definition) of a patient's life. This care is managed and coordinated by a certified Medicare hospice provider.

Hypnotic Medication - A psychoactive medication given to sedate or calm (e.g., Sonata, Restoril, Ambien).

Immediate Jeopardy - A situation in which a provider's noncompliance with one or more regulations has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident (patient).

Incidence - A type of CHSRA QI that provides a description of what has taken place with a resident (patient) over the course of the last two MDS or OASIS assessments.

Independent or Instrumental Activities of Daily Living (IADLs) - Activities that include meal preparation, housework (e.g., cooking), managing finances (e.g., keeping a checkbook) or medications, telephone use, shopping, and transportation (e.g., how one moves up and down stairs, how one moves in and out of cars).

Individual Program Plan - A written statement of the services to be provided, as developed by an interdisciplinary team, and based on a comprehensive functional assessment of an individual's active treatment needs.

Informed Consent - The person giving consent receives information necessary to make a health care decision, including information about the benefits, reasonable risks, alternatives, the right to refuse, and consequences of any treatment or service.

Initial Survey - An on-site Federal survey to determine whether a provider meets the requirements to begin participating in the Medicare and/or Medicaid programs.

Interdisciplinary Team - A group of professionals from various disciplines who work together to provide services to the greatest benefit of the individual.

Intermediate Care Facility (ICF) - State term for a facility which is licensed to provide intermediate nursing care which includes physical, emotional, social, and rehabilitative services under periodic medical review and requiring the skill of a registered nurse to supervise the care.

Intermediate Care Facility for the Mentally Retarded (ICF/MR) - An institution that meets the Federal Conditions of Participation and has a primary purpose of providing health or rehabilitation services to individuals with mental retardation or related conditions receiving care and services under the Medicaid program.

Joint Commission on Accreditation of Healthcare Agencies (JCAHO) - An independent, not-for-profit organization that evaluates and accredits nearly 19,000 health care organizations and programs in the United States.

K Tags - Data tags used to identify specific Federal Life Safety Code regulations in the OSCAR data system (see also OSCAR).

Licensed Practical Nurse (LPN) - A person licensed as a practical nurse by State statute. An LPN performs simple acts in the care of convalescent, subacute or chronically ill patients; or provides care to acutely ill patients under the specific direction of a registered nurse, physician, podiatrist, or dentist.

Licensure - The granting of a license to a provider that has been determined to meet a State's requirements for operation.

Life Safety Code (LSC) - Resident fire safety and protection requirements adopted by reference from standards developed by the National Fire Protection Association (NFPA).

Long Term Care (LTC) - A general term used to describe care in nursing homes. This term is also used to describe a broader continuum of care for chronic and disabled persons that include nursing homes, assisted living facilities, board and care facilities, and community care such as home health agencies.

Medicaid - A State program that provides medical services to clients of the State public assistance program and, at the State's option, other needy individuals, as well as supplements hospital and nursing facility (NF) services that are mandated under Medicaid. States may decide on the amount, duration, and scope of additional services. Generally, the only types of institutions participating solely in Medicaid are Nursing Facilities (NFs) and intermediate care facilities for the mentally retarded (ICFs/MR).

Medical Doctor (MD) - A physician licensed by state law to practice medicine.

Medical Nutrition Therapy - A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease or increase specific nutrients in the diet. (May also be called Therapeutic Diet).

Medicare - A Federal insurance program providing a wide range of benefits for specific periods of time through providers and suppliers participating in the program. Providers, in Medicare, are patient care institutions such as hospitals, hospices, nursing homes, and home health agencies. Benefits are payable for most people over age 65, Social Security beneficiaries under 65 entitled to disability benefits, and individuals needing renal dialysis or renal transplantation. Payment for services is made by the Federal Government through designated fiscal intermediaries (FIs) and carriers to the providers and suppliers.

Medication Error - Medications not given as intended by prescriber, as required by the drug manufacturer, or according to acceptable professional standards.

Mental Illness (MI) - Individuals with organic or non-organic psychiatric diagnoses. Nursing homes are not normally allowed to admit and care for individuals with non-organic psychiatric diagnoses between the ages of 22 - 64 if they wish to receive Medicaid reimbursement.

Mental Retardation (MR) - Individuals with significant limitations in intellectual functioning and adaptive behavior characterized by impaired learning ability and impaired practical, social, and vocational skills. The application of the term mental retardation reflects the need for personalized supports that consider limitations in context of the individual's cultural community, linguistic diversity, and age peer group. (Adopted from the AAMR definition.)

Minimum Data Set (MDS) - A Federally mandated resident assessment instrument used to assess resident physical, mental, emotional, cognitive, and functional limitations and strengths. The MDS must be administered to all residents in Medicare or Medicaid certified facilities at time of admission, annually, quarterly, and when a significant change in a resident's condition occurs.

Misappropriation - The deliberate misplacement, exploitation, or wrongful, temporary, or permanent use of a resident's (patient's) belongings or money without the resident's consent.

Neglect - Failure to provide goods and services to prevent resident (patient) harm.

Nosocomial Infection in the Long Term Care Facility - An infection that develops after admission to the LTCF. Infections that are incubating at the time of admission, or develop within 48 to 72 hours of admission, usually are community-acquired, or hospital associated if the person was transferred from the hospital.

NUN - The Network UserName (NUN) identifies the facility (or corporation) from which you have logged on to the ePIP website. Each facility (or corporation) receives one NUN that is used by all of its members.

Nurse Aide, Nursing Assistant (NA) - An unlicensed caregiver, under professional nurse supervision, who provides nursing and personal care.

Nurse Aide Competency - Federal and/or State training and capability requirements needed for employment of nurse aides in nursing homes.

Nurse Aide Registry - A listing of nurse aides who have met Federal and/or State training and competency requirements needed for employment in nursing homes.

Nurse Practitioner - A registered nurse who meets additional state requirements to meet this designation. In some states, nurse practitioners may act as physician extenders to conduct certain activities such as ordering tests and medications.

Nursing Facility (NF) - A nursing home that meets the requirements for Medicaid certification as defined in 1919(a) of the Federal Social Security Act.

Nursing Home Quality Improvement Initiative - A program of the Centers for Medicare and Medicaid Services (CMS) and U.S. Department of Health and Human Services that compiles information about nursing home residents on eight situations/conditions called Quality Measures (QMs) and makes the information available to consumers.

Occupational Therapist (OT) - A person licensed, certified, or registered under State statutes to perform as an occupational therapist. Generally these individuals are certified by the American Occupational Therapy Association (AOTA).

Ombudsman - Paid or voluntary staff that investigate nursing home complaints from residents and their families and act as resident advocates addressing concerns of nursing home residents. Many Ombudsman programs are associated with State Departments or Boards of Aging.

Omnibus Budget Reconciliation Act of 1987 (OBRA) - Changes to the Federal Social Security Act that significantly changed how nursing homes and home health agencies are regulated for Medicare and Medicaid certification.

Online Survey/Certification and Reporting (OSCAR) - CMS database that includes Medicare and Medicaid certified facility demographic information, results of on-site surveys, and aggregate nursing home resident characteristics for comparison with state and national peer information.

ORYX - A project of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) to use performance measurement data to support its survey and accreditation activities. All JCAHO accredited hospitals, long term care organizations and home health agencies must participate in the program by using an acceptable performance measurement system. CHSRA is a JCAHO accepted performance system for long term care organizations.

Outcome - The status of care provided to a resident (patient).

Outcome and Assessment Information Set (OASIS) - A group of data elements that represent core items of a comprehensive assessment for an adult home care resident (patient) and used for measuring patient outcomes in quality improvement.

Outliers - Providers that fall so far outside of acceptable levels that investigation is warranted. "Outlier" implies an extreme condition. In terms of CHSRA QI reports, an outlier would be above the threshold of the 90th percentile (see also Percentile Rank and Threshold).

Palliative Care - Management and support provided for the reduction or abatement of pain, for other physical symptoms and for psychosocial and spiritual needs of individuals with terminal illness and includes physician services, skilled nursing care, medical services, social services, services of volunteers and bereavement services, but does not mean treatment provided to cure a medical condition or disease or to artificially prolong life.

Peer Groups - The other providers in a group that are used for comparison purposes.

Percentile Rank - For the CHSRA QIs, a means of ranking providers based on how they compare with each other on each separate QI. The higher a provider's percentile ranking, the more apt the provider is to have a care concern.

Physical Restraint - Devices that prevent or restrict resident (patient) movement. A device or manual method that works to treat a medical symptom(s) but is attached to or adjacent to the individual's body so that freedom of movement or normal access to one's body is restricted.

Physical Therapist - A person licensed, certified, or registered by State statute to perform as a physical therapist. Generally these individuals are certified by the American Physical Therapy Association (APTA).

Physician Assistant (PA) - A person licensed or certified by State statute to perform as a Physician Assistant.

Physician Extender - A Physician Assistant or Nurse Practitioner acting under the general supervision and direction of a physician.

Plan of Correction (POC) - A provider's plan for how and when it will correct Federal deficiencies and/or State violations.

Post-Acute Care - Care for residents (patients) who are admitted to a facility following an acute care hospitalization. Care may involve high-intensity rehabilitation or clinically complex care. Most post-acute stays are for less than 30 days. Some post-acute stays lead to long term admissions for chronic care.

Post-Survey Revisit - An on-site provider visit intended to verify correction of deficiencies and/or violations cited during a survey.

Preadmission Screening/Annual Resident Review Reports (PASARR) - Federally required screening of all nursing home residents, prior to admission, to determine if the individual residents are mentally ill or mentally retarded.

Pressure Sore/Ulcer - An inflamed lesion of the skin or internal mucous tissue caused by pressure or friction. Pressure sores are classified (Stages from 1-4) for increasing severity.

Prevalence - A type of QI or QM that provides a description of a resident or patient at a point.

Prior Assessment - The assessment that occurs in the most recent four months (46-165 days) preceding the target assessment. (See Assessment and Target Assessment.)

Provider Initiative Project (PIP) - A quality indicator information system for long term care developed by the Center for Health Systems Research and Analysis (CHSRA) at the University of Wisconsin-Madison that utilizes MDS assessment data.

Psychoactive Medication - Medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.

Psychotropic Medications - Psychoactive medications used to change, modify, or alter an individual's behavior or mood. This general term includes antianxiety, antidepressant, antipsychotic, and hypnotic medications.

PUID - The Personal User ID (PUID) is an individual logon that is unique to each staff member who uses the ePIP system. New IDs can be requested at any time by contacting the ePIP help desk.

QI Domain - For the CHSRA QIs, the broad areas of care that represent the common conditions and important aspects of care and life to nursing home residents. Each domain is represented by one or more QIs.

Qualified Mental Retardation Professional (QMRP) - A person who has at least one year of experience working directly with persons with mental retardation or other developmental disabilities and is one of the following: a doctor of medicine or osteopathy, a registered nurse, or an individual who holds at least a bachelor's degree in a professional program service area. The professional program staff must be licensed, certified, or registered, as applicable, to provide professional services by the State in which he or she practices. Those program staff that does not fall under the jurisdiction of State licensure, certification, or registration requirements, must meet specific eligibility qualifications set forth by the CMS. A person who is responsible for ensuring quality care for a group of persons with mental disabilities.

Quality Assurance - A provider program to monitor and study the quality of the services it delivers, and to make recommendations for improvement. A designated Quality Assurance Committee usually coordinates this activity.

Quality Improvement Organizations (QIOs) - State organizations funded by the CMS "to ensure the quality, effectiveness, efficiency and economy of health care services provided to Medicare beneficiaries," formerly referred to as Peer Review Organizations, or PROs. The 53 QIOs have been designated to provide educational materials and programs to nursing homes in their State to assist them in understanding and using the publicly reported quality measures (QMs).

Quality Indicators (QIs) - CHSRA's indicators of provider level and resident (patient) level status derived from MDS (OASIS) information. The QIs are pointers or signposts of potential resident (patient) and/or provider care problems. QIs are used by surveyors to help structure the survey process and can be used by providers to help monitor and improve their own performance.

Quality Measures (QMs) - Publicly reported information made available by CMS to help consumers assess the quality of nursing home care. There are two categories of quality measures: (1) conditions relevant primarily to long-term residents (patients) (chronic care), including decline in late loss ADLs, pressure sores, residents with pain, physical restraints, and prevalence of infections; and (2) short-stay (temporary) residents (patients) (post-acute care), specifically prevalence of delirium, residents with pain, and improvement in walking. Many of the QMs are based on, and virtually identical to, QIs.

Quality of Care - General area of the Federal nursing home requirements that addresses specific areas.

Quality of Life - General area of the Federal nursing home regulations that addresses resident (patient) life issues such as dignity, participation in activities, social services, accommodation of needs, and the facility's environment such as lighting, sound temperature, and homelike environment.

Quarterly Assessments - MDS assessments required each quarter for all residents (patients) in Medicare and/or Medicaid facilities.

Range of Motion (ROM) - The extent or magnitude of a 'resident's (patient's) joint movement.

Recreational Therapist (RT) - A person certified, by a recognized certifying organization, to perform as a recreational therapist.

Regional Office (RO) - CMS Offices that serve ten distinct CMS regions. (Office Locations: Region 1 - Boston; Region 2 - New York City; Region 3 - Philadelphia; Region 4 - Atlanta; Region 5 - Chicago; Region 6 - Dallas; Region 7 - Kansas City; Region 8 - Denver; Region 9 - San Francisco; Region 10 - Seattle.)

Registered Dietitian (RD) - A person registered as a dietitian by State statute or the American Dietetics Association.

Registered Nurse (RN) - A person registered as a nurse by State statute.

Registered Pharmacist (RPh) - A person registered as a pharmacist by State statute.

Regulations - Federal requirements promulgated to "flesh out" the statutory requirements in the Social Security Act (see also Rules and Statutory Requirement).

Report Set - Report Sets are a new feature of ePIP that allows you to create a collection of reports using parameters you define. They can be saved and run whenever they are needed. It is completely up to you to choose which reports and parameters you want to include in your Report Sets and you can also include multiple copies of the same report with different parameters if that is what you need. For example, if you would like a list of residents with weight loss QI or a decubitus ulcer for your nutritionist every month, define a new report set with the proper Individual QI Series reports selected, and save it. Each month a simple click or two will generate a new, up-to-date list for you.

Resident Assessment Instrument (RAI) - A tool to help facilities identify residents' needs and strengths and develop an appropriate care plan. The Federal RAI system includes: the MDS, RAPS, and Utilization Guidelines.

Resident Assessment Protocols (RAPs) - Eighteen problem-oriented guides for care planning with "trigger" conditions to signal the need for additional assessment and review (e.g., Activities RAP, Mood State RAP, Pressure Ulcer RAP, etc.)

Resource Utilization Groups (RUGS) - A collection of nursing facility resident classification systems used in a variety of case mix indexed reimbursement systems. Using assessment tools like the MDS 2.0, these systems group residents by expected level of resource utilization, usually based upon staff time measurements per resident per day. Relative resource utilization is reflected in a case mix index (CMI) value assigned to each RUG cell.

Respite Care - Temporary placement of a resident (patient) in a facility for maintenance of care, treatment, or services as established by the primary care giver.

Risk Adjustment - A method of statistically controlling for resident (patient) level differences that can affect the measurement of a QI or QM. Risk adjustment is used to "level the playing field," so that fair comparisons can be make between providers who serve residents (patients) with different risk of experiencing a QI or QM. There are several different methods of risk adjustment. The QIs use a stratification approach; the QMs use a regression-based approach.

Risk Groups - An assessment of a 'resident's (patient's) likelihood for development of a condition incorporated into a QI itself. QIs flag for either those persons identified at HIGH risk or those who are not at risk - LOW risk. This concept has implications for assessing how providers intervene with residents (patients) who are vulnerable to certain conditions because their diagnosis or physical/mental status, and also how facilities intervene with residents (patients) who are not as vulnerable. LOW risk groups should get special attention because residents (patients) in this group have developed the QI condition in the absence of factors related to their diagnoses or physical/mental condition. High and low risk QIs should be considered as separate QIs.

Rule - State requirements promulgated to "flesh out" the State Statutes (see also Regulations and Statutory Requirement).

Scope - The extent or magnitude of deficient facility practice on resident (patient) outcome. There are three levels of scope as described in the Federal Enforcement Grid (see also Enforcement Grid).

Sentinel Health Events - Significant conditions or events that exist for only a single case or a few cases. For the CHSRA QI, they may represent a significant problem that needs to be investigated (e.g., Fecal Impaction, Dehydration, Pressure Ulcers - Low Risk).

Severity - The effect or seriousness of deficient facility practice on resident (patient) outcome. There are four levels of severity as described in the Federal Enforcement Grid (see also Enforcement Grid).

Short Term Stay - Admission and discharge of a nursing home resident (patient) that occurs in less than 14 days.

Side Effect - Undesirable effect of a medication that causes minimal discomfort in some people.

Significant Change in Condition - A substantial modification in a resident's (patient's) ' physical, mental, emotional, cognitive, or functional status that requires a new assessment using the MDS instrument, and also generally requires notification of the resident's (patient's) attending physician, family, or guardian.

Significant Medication Error - Medication error that causes a resident (patient) discomfort and/or jeopardizes his/her health and safety.

Skilled Nursing Facility (SNF) - A nursing home that meets the requirements for Medicare certification as defined in 1819(a) of the Federal Social Security Act. Also the term used by most States to define the type of nursing home that is licensed to provide the highest level of care.

Speech Pathologist (SP) - A person licensed, certified, or registered by State statute to perform as a speech pathologist.

Speech Therapist (ST) - A person licensed, certified, or registered by State statute to perform as a speech therapist.

Social Security Act - Federal statutory law that includes the requirements for participation in the Medicare and Medicaid programs.

Standard Survey - An on-site Federal survey of nursing homes conducted every 9 -15 months to determine compliance with Federal regulations for Medicare and/or Medicaid.

Statement of Deficiency (SOD) - A written summary of noncompliance with regulations found during a Federal provider survey or complaint investigation (see also Violation). Statements of Deficiency are written on a CMS 2567 form.

Statutory Requirement - Federal law passed by Congress such as the Social Security Act. In State terminology is also known as a statute (see also Regulation or Rule).

Sub-unit - A Sub-unit is a unique group of residents within your facility that has been defined as part of a Classification for use in the ePIP system. Sub-units are mutually exclusive within each classification. Once a Sub-unit has been created, it can be set as a report parameter when requesting reports.

Some facilities are using this feature to separate out one floor of a facility from the other floors using the room number field on the MDS. Then, for instance, separate QI Profiles and resident QI summaries can be requested for each floor.

Subacute - Type of nursing home care that is generally considered above skilled nursing but below acute hospital care.

Substandard Care - Substandard quality of care is any deficiency in 42 CFR 483.13 - Resident Behavior and Facility Practice, 42 CFR 483.15 - Quality of Life or 42 CFR 483.25 - Quality of Care that constitutes immediate jeopardy to resident (patient) health or safety; or a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm that is not immediate jeopardy, with no actual harm. On the Federal Enforcement Grid, substandard care equates to boxes F, H, I, J, K and L, and results in imposition of penalties (see also Enforcement Grid).

Substantial Compliance - Minor deficiencies or violations, but a facility generally meets the intent of Federal or State regulations. On the Federal Enforcement Grid, Substantial Compliance is equated to findings in boxes A - C (see also Enforcement Grid).

Target Assessment - The most recent full (AA8a= 01,02,03 or 04) or quarterly assessment (AA8a = 05 or 10) that is available for the time in which the QM score is calculated. (See Assessment and Prior Assessment.)

Terminal Care - Care provided to a dying resident (patient) that may or may not include hospice care (see also Hospice Care).

Therapeutic Diet - A diet ordered by a physician as part of treatment for a disease or clinical condition, or to eliminate, decrease, or increase specific nutrients in the diet. (May also be called Medical Nutrition Therapy).

Threshold - A set point for each CHSRA QI at which the likelihood of a problem is sufficient to warrant further investigation. There may also be a concern below the threshold especially if the percentile rank is close to the threshold. Generally, the threshold point is set at the 90th percentile (see also Percentile Rank).

Unnecessary Drug - Any of the following: drug that is given without a medical reason; drug given in excessive dose; drug given for an excessive amount of time drug without adequate monitoring; drug given with side effects and/or adverse drug reactions indicate the drug should be reduced or discontinued.

Universal Precautions - Measures taken to prevent transmission of infection from contact with blood or other body fluids or materials having blood or other body fluids on them, as recommended by the U.S. Public Health Services Centers for Disease Control and adopted by the US Occupational Safety and Health Administration (OSHA) as 29 CFR 1910.1030.

Variance - The granting of an alternate requirement in place of a Federal or State regulation (see also Waiver).

Ventilator - A device to mechanically assist a resident (patient) to breathe.

Violation - A written summary of noncompliance with regulations found during a State provider survey or complaint investigation (see also Statement of Deficiency). The written document is generally called a Notice of Violation.

W Tags - Data tags used to identify specific Federal intermediate care facilities for the mentally retarded (ICF/MR) regulations in the OSCAR data system (see also OSCAR).

Waiver - The granting of an exemption from a Federal or State regulation (see also Variance).