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Flashcards in Disability / Health & Human Services Deck (107):


A term used to denote building facilities that are barrier-free thus enabling all members
of society safe access, including persons with physical disabilities.


Activity Limitations

Difficulties an individual may have in executing activities.
May range from a slight to a severe deviation in terms of quality or quantity in executing the activity in a manner or to the extent that is expected of people without the health condition.



A physical, manmade environment or arrangement of structures that is safe and
accessible to persons with disabilities.


Developmental Disability

Any mental and/or physical disability that has an onset before age 22 and may continue indefinitely. It can limit major life activities. Individuals with mental retardation,
cerebral palsy, autism, epilepsy (and other seizure disorders), sensory impairments, congenital disabilities, traumatic brain injury, or conditions caused by disease (e.g., polio and muscular dystrophy) may be considered to be this.



1) A physical or neurological deviation in an individual makeup. It may refer to a physical,
mental or sensory condition.
May or may not be a handicap to an individual, depending on one’s adjustment to it. 2) Diminished function, based on the anatomic, physiological or mental
impairment that has reduced the individual's activity or presumed ability to engage in any substantial gainful activitity. 3) Inability or limitation in performing tasks, activities, and roles in the manner or within the range considered normal for a person of the same age, gender, culture and education.
Can also refer to any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being.


Disability Case Management

A process of managing occupational and nonoccupational diseases with the aim of returning the disabled employee to a productive work schedule and employment.


Disability Income Insurance

A form of health insurance that provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury, or disease.



The functional disadvantage and limitation of potentials based on a physical or mental
impairment or disability that substantially limits or prevents the fulfillment of one or more major life activities, otherwise conisdered norml for that individual based on age, sex, and social and cultural factors, such as caring for one’s self, performing manual tasks, walking, seeing, hearing, speaking,
breathing, learning, working, etc.
Is a classification of role reduction resulting from circumstances that place an impaired or disabled person at a disadvantage compared to other persons.



Refers to the disadvantage of an individual with a physical or mental impairment
resulting in a handicap.


Learning Disability

A lack of achievement or ability in a specific learning area(s) within the range of
achievement of individuals with comparable mental ability. Most definitions emphasize a basic disorder in psychological processes involved in understanding and using language, spoken or written.


SSDI (Social Security Disability Income)

Federal benefit program sponsored by the Social Security Administration.
Primary factor: disability and/or benefits received from deceased or disabled parent,
benefit depends upon money contributed to the Social Security program either by the individual involved and/or the parent involved.


Total Disability

An illness or injury that prevents an insured person from continuously performing
every duty pertaining to his/her occupation or engaging in any other type of work.


Adverse Events

Any untoward occurrences, which under most conditions are not natural consequences of the patient's disease process or treatment outcomes.



The observable emotional condition of an individual at any given time.



The chronological delineation of the steps in, or activities of, patient care to be applied in
the care of patients as they relate to specific conditions/situations.


Alternate Level of Care

A level of care that can safely be used in place of the current level and
determined based on the acuity and complexity of the patient's condition and the type of needed services and resources.


Ancillary Services

Other diagnostic and therapeutic services that may be involved in the care of
patients other than nursing or medicine. Includes respiratory, laboratory, radiology, nutrition, physical and occupational therapy, and pastoral services.


Appropriateness of Setting

Used to determine if the level of care needed is being delivered in the most appropriate and cost-effective setting possible.



The process of collecting in-depth information about a person’s situation and
functioning to identify individual needs in order to develop a comprehensive case management plan that will address those needs. In addition to direct client contact, information should be gathered from
other relevant sources (patient/client, professional caregivers, non-professional caregivers, employers, health records, educational/military records, etc.).


Care Management

A healthcare delivery process that helps achieve better health outcomes by
anticipating and linking clients with the services they need more quickly. It also helps avoid unnecessary services by preventing medical problems from escalating.


Case Management

A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s health needs, using
communication and available resources to promote quality, cost-effective outcomes.


Case Management Plan

A timeline of patient care activities and expected outcomes of care that address the plan of care of each discipline involved in the care of a particular patient. It is usually
developed prospectively by an interdisciplinary healthcare team in relation to a patient's diagnosis, health problem, or surgical procedure.


Case Manager

A healthcare professional who is responsible for coordinating the care delivered to
an assigned group of patients based on diagnosis or need. Other responsibilities include patient/family education, advocacy, delays management, and outcomes monitoring and management.
They work with people to get the healthcare and other community services they need,
when they need them, and for the best value.


Case-Based Review

The process of evaluating the quality and appropriateness of care based on
the review of individual medical records to determine whether the care delivered is acceptable. It is performed by healthcare professionals assigned by the hospital or an outside agency (e.g., Peer Review Organization [PRO]).



The total number of patients followed by a case manager at any point in time.


Clinical Pathway (See Case Management Plan)

A timeline of patient care activities and expected outcomes of care that
address the plan of care of each discipline involved in the care of a particular patient. It is usually developed prospectively by an interdisciplinary healthcare team in relation to a patient's diagnosis, health problem, or surgical procedure.



A mechanism of identifying and defining patient care services/activities as primary and
secondary diagnoses and procedures. The process is guided by the ICD-9-CM coding manual, which lists the various codes and their respective descriptions.
Usually done in preparation for
reimbursement for services provided.


Communication Skills

Refers to the many ways of transferring thought from one person to another
through the commonly used media of speech, written words, or bodily gestures.



Agreement in opinion of experts. Building this is a method used when developing case management plans.


Continuous Quality Improvement (CQI)

A key component of total quality management that uses rigorous, systematic, organization-wide processes to achieve ongoing improvement in the quality of healthcare services and operations. It focuses on both outcomes and processes of care.


Continuum of Care

Matches ongoing needs of the individuals being served by the case management process with the appropriate level and type of health, medical, financial, legal and psychosocial care for services within a setting or across multiple settings.



The process of organizing, securing, integrating, and modifying the resources
necessary to accomplish the goals set forth in the case management plan.


Custodial Care

Care provided primarily to assist a patient in meeting the activities of daily living but
not requiring skilled nursing care.


Delay in Service

Used to identify delays in the delivery of needed services and to facilitate and
expedite such services when necessary.


Discharge Outcomes (criteria)

Clinical criteria to be met before or at the time of the patient's discharge. They are the expected/ projected outcomes of care that indicate a safe discharge.


Discharge Planning

The process of assessing the patient's needs of care after discharge from a
healthcare facility and ensuring that the necessary services are in place before discharge. This process ensures a patient's timely, appropriate, and safe discharge to the next level of care or setting including appropriate use of resources necessary for ongoing care.


Discharge Status

Disposition of the patient at discharge (e.g., left against medical advice, expired,
discharged home, transferred to a nursing home).


Disease Management

A system of coordinated healthcare interventions and communications for populations with chronic conditions in which patient self-care efforts are significant. It supports the physician or practitioner/patient relationship.
The plan of care emphasizes prevention of exacerbations and complications
utilizing evidence-based practice guidelines and patient empowerment strategies, and
evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.


Effectiveness of Care

The extent to which care is provided correctly (i.e., to meet the patient's needs, improve quality of care, and resolve the patient's problems), given the current state of
knowledge, and the desired outcome is achieved.


Efficacy of Care

The potential, capacity or capability to produce the desired effect or outcome, as
already shown, e.g. through scientific research (evidence-based) findings.


Efficiency of Care

The extent to which care is provided to meet the desired effects/outcomes to improve quality of care and prevent the use of unnecessary resources.


First-Level Reviews

Conducted while the patient is in the hospital, care is reviewed for its appropriateness.



A system of inpatient and outpatient care, which is supportive and palliative family centered care, designed to assist the individual with terminal illness to be comfortable and maintain a
satisfactory lifestyle through the end of life.



The process of executing specific case management activities and/or interventions
that will lead to accomplishing the goals set forth in the case management plan.


Independent Case Management

Also known as private case management or external case management, it entails the provision of case management services by case managers who are either self-employed or are salaried employees in a privately owned case management firm.


Independent Living

A service delivery concept that encourages the maintenance of control over
one’s life based on the choice of acceptable options that minimize reliance on others performing everyday activities.



A measure or metric that can be used to monitor and assess quality and outcomes of
important aspects of care or services. It measures the performance of functions, processes, and outcomes of an organization.



Harm to a worker subject to treatment and/or compensable under workers' compensation.
Any wrong, or damages done to another; either done to his/her person, rights, reputation, or property.


Integrated Delivery System (IDS)

A single organization or group of affiliated organizations that provides a wide spectrum of ambulatory and tertiary care and services. Care may also be provided
across various settings of the healthcare continuum.


Intensity of Service

An acuity of illness criteria based on the evaluation/treatment plan, interventions, and anticipated outcomes.


Intermediate Outcome

A desired outcome that is met during a patient's hospital stay. It is a milestone in the care of a patient or a trigger point for advancement in the plan of care.



Planned strategies and activities that modify a maladaptive behavior or state of being
and facilitate growth and change.
Is analogous to the medical term TREATMENT.
May include activities such as advocacy, psychotherapy, or speech language therapy.


Level of Care

The intensity of effort required to diagnose, treat, preserve or maintain an individual's
physical or emotional status.


Levels of Service

Based on the patient's condition and the needed level of care, used to identify
and verify that the patient is receiving care at the appropriate level.



A permit to practice medicine or a health profession that is: 1) issued by a state or
jurisdiction in the United States; and 2) required for the performance of job functions.


Managed Competition

A state of healthcare delivery in which a large number of consumers choose among health plans that offer similar benefits. In theory, competition would be based on cost and
quality and ideally would limit high prices and improve quality of care.


Management Service Organization

A management entity owned by a hospital, physician organization, or third party. It contracts with payers and hospitals/physicians to provide certain
healthcare management services such as negotiating fee schedules and handling administrative functions, including utilization management, billing, and collections.


Medical Loss Ratio (MLR)

The ratio of healthcare costs to revenue received. Calculated as total
medical expense divided by total revenue.


Medical Necessity on Admission

A type of review used to determine that the hospital admission is appropriate, clinically necessary, justified, and reimbursable.


Medically Necessary

A term used to describe the supplies and services provided to diagnose and
treat a medical condition in accordance with nationally recognized standards.


Minimum Data Set (MDS)

The assessment tool used in skilled nursing facility settings to place patients into Resource Utilization Groups (RUGs), which determines the facilities reimbursement rate.



The ongoing process of gathering sufficient information from all relevant sources about
the case management plan and its activities and/or services to enable the case manager to determine the plan’s effectiveness.


Multidisciplinary Action Plan (MAP) or
Case Management Plan (CMP).

A timeline of patient care activities and expected outcomes of care that
address the plan of care of each discipline involved in the care of a particular patient. It is usually developed prospectively by an interdisciplinary healthcare team in relation to a patient's diagnosis, health problem, or surgical procedure.


Nondisabling Injury

An injury which may require medical care, but does not result in loss of working time or income.


Nursing Case Management
or Case Management.

A process model using the components
of case management in the delivery aspects of nursing care. In nursing case management delivery systems, the role of the case manager is assumed by a registered professional nurse.



The result and consequence of a healthcare process. A good one is a result that
achieves the expected goal.
May be the result of care received or not received. It represents the cummulative effects of one or more processes on a client at a defined point in time.


Outcome and Assessment Information Set (OASIS)

A prospective nursing assessment
instrument completed by home health agencies at the time the patient is entered for home health services. Scoring determines the Home Health Resource Group (HHRG).


Outcome Indicators

Measures of quality and cost of care. Metrics used to examine and evaluate the results of the care delivered.


Outcomes Measurement

The systematic, quantitative observation, at a point in time, of outcome indicators.


Outcomes Monitoring

The repeated measurement over time of outcome indicators in a manner
that permits causal inferences about what patient characteristics, care processes, and resources produced the observed patient outcomes.



Something that is significantly well above or below an expected range or level.


Outlier Threshold

The upper range (threshold) in length of stay before a patient's stay in a hospital
becomes an outlier. It is the maximum number of days a patient may stay in the hospital for the same fixed reimbursement rate. The outlier threshold is determined by the Centers for Medicare and Medicaid Services (CMS), formerly known as the Health Care Financing Administration (HCFA).



Using established criteria as a guide, determination is made as to whether the
patient is receiving services that are redundant, unnecessary, or in excess.


Partial Disability

The result of an illness or injury which prevents an insured from performing one or
more of the functions of his/her regular job.


Performance Improvement

The continuous study and adaptation of the functions and processes of
a healthcare organization to increase the probability of achieving desired outcomes and to better meet the needs of patients.


Physical Disability

A bodily defect that interferes with education, development, adjustment or rehabilitation; generally refers to crippling conditions and chronic health problems but usually does
not include single sensory handicaps such as blindness or deafness.



The process of determining specific objectives, goals, and actions designed to meet the client’s needs as identified through the assessment process. The plan should be action-oriented and time-specific.


Practice Guidelines (Guidelines)

Systematically developed statements on medical practices that assist a practitioner in making decisions about appropriate diagnostic and therapeutic healthcare
services for specific medical conditions. Practice guidelines are usually developed by authoritative professional societies and organizations such as the American Medical Association.


Premature Discharge

The release of a patient from care before he or she is deemed medically stable and ready for terminating treatment/care (e.g., discharging a patient from a hospital when he or
she is still needing further care and/or observation).


Primary Care

The point when the patient first seeks assistance from the medical care system. It
also is the care of the simpler and more common illnesses.


Principal Diagnosis

The chief complaint or health condition that required the patient's admission to
the hospital for care.


Principal Procedure

A procedure performed for definitive rather than diagnostic treatment, or one
that is necessary for treating a certain condition. It is usually related to the primary diagnosis.


Prospective Review

A method of reviewing possible hospitalization before admission to determine
necessity and estimated length of stay.



A systematically written document about a specific patient's problem. It is mainly used as an integral component of a clinical trial or research. It also delineates the steps to be followed for a particular procedure or intervention to meet desired outcomes.



A person or entity that provides health care services. This includes both practitioners and


Quality Assurance

The use of activities and programs to ensure the quality of patient care. These
activities and programs are designed to monitor, prevent, and correct quality deficiencies and noncompliance with the standards of care and practice.


Quality Improvement

An array of techniques and methods used for the collection and analysis of data gathered in the course of current healthcare practices in a defined care setting to identify and
resolve problems in the system and improve the processes and outcomes of care.


Quality Indicator

A predetermined measure for assessing quality; a metric.


Quality Management

A formal and planned, systematic, organizationwide (or networkwide)
approach to the monitoring, analysis, and improvement of organization performance, thereby continually improving the extent to which providers conform to defined standards, the quality of patient care and services provided, and the likelihood of achieving desired patient outcomes.


Quality Monitoring

A process used to ensure that care is being delivered at or above acceptable
quality standards and as identified by the organization or national guidelines.


Report Card

An emerging tool that is used by healthcare providers, purchasers, policymakers,
governmental agencies, and consumers to compare and understand the actual performance of health plans and other service delivery programs. It usually includes data in major areas of accountability such as quality, utilization of resources, consumer satisfaction, and cost.


Resource Utilization Group (RUG)

Classifies skilled nursing facility patients into 7 major hierarchies and 44 groups. Based on the MDS, the patient is classified into the most appropriate group, and with the highest reimbursement.


Retrospective Review

A form of medical records review that is conducted after the patient's discharge to track appropriateness of care and consumption of resources.



The course of action adopted to care for a patient or to prevent disease.



Any expected outcome that has not been achieved within designated timeframes. It also means delay of specific diagnostic or therapuetic intervention. Categories include system, patient, and practitioner.


Outcomes Management

The use of information and knowledge gained from outcomes monitoring to achieve optimal patient outcomes through improved clinical decision making and service delivery.


Risk Management

The science of the identification, evaluation, and treatment of financial (and
clinical) loss. A program that attempts to provide positive avoidance of negative results.


Root Cause Analysis

A process used by healthcare providers and administrators to identify the basic or causal factors that contribute to variation in performance and outcomes or underlie the
occurrence of a sentinel event.


Second Opinion

An opinion obtained from another physician regarding the necessity for a treatment that has been recommended by another physician. May be required by some health plans for certain high-costs cases, such as cardiac surgery.


Severity of Illness

An acuity of illness criteria that identifies the presence of significant/debilitating
symptoms, deviations from the patient's normal values, or unstable/abnormal vital signs or laboratory findings.


Skilled Care

Patient care services that require delivery by a licensed professional such as a
registered nurse or physical therapist, occupational therapist, speech pathologist, or social worker.


Social Work

Promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being.
Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments.
Principles of human rights and social justice are fundamental to social work.


Special Education

A broad term covering programs and services for children who deviate physically, mentally or emotionally from the normal to an extent that they require unique learning
experience, technology or materials in order to be maintained in the regular classrooms and
specialized classes and programs of the problems are more severe.


Subacute Care Facility

A healthcare facility that is a step down from an acute care hospital and a step up from a conventional skilled nursing facility intensity of services.


Telephone Triage

Triaging patients to appropriate levels of care based on a telephonic assessment
of a patient. Case managers use the findings of their telephone-based assessment to categorize the patient to be of an emergent, urgent, or nonurgent condition.


Telephonic Case Management

The delivery of healthcare services to patients and/or families or caregivers over the telephone or through correspondence, fax, e-mail, or other forms of electronic
transfer. An example is telephone triage.


Transitional Planning

The process case managers apply to ensure that appropriate resources and services are provided to patients and that these services are provided in the most appropriate setting
or level of care as delineated in the standards and guidelines of regulatory and accreditation
agencies. It focuses on moving a patient from most complex to less complex care setting.