Disability / Health & Human Services

Question 1

Accessible

Answer 1

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

Question 2

Activity Limitations

Answer 2

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.

Question 3

Barrier-Free

Answer 3

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

Question 4

Developmental Disability

Answer 4

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.

Question 5

Disability

Answer 5

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.

Question 6

Disability Case Management

Answer 6

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

Question 7

Disability Income Insurance

Answer 7

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.

Question 8

Handicap

Answer 8

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.

Question 9

Handicapped

Answer 9

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

Question 10

Learning Disability

Answer 10

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.

Question 11

SSDI (Social Security Disability Income)

Answer 11

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.

Question 12

Total Disability

Answer 12

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.

Question 13

Adverse Events

Answer 13

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

Question 14

Affect

Answer 14

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

Question 15

Algorithm

Answer 15

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.

Question 16

Alternate Level of Care

Answer 16

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.

Question 17

Ancillary Services

Answer 17

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.

Question 18

Appropriateness of Setting

Answer 18

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

Question 19

Assessment

Answer 19

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.).

Question 20

Care Management

Answer 20

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.

Question 21

Case Management

Answer 21

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.

Question 22

Case Management Plan

Answer 22

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.

Question 23

Case Manager

Answer 23

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.

Question 24

Case-Based Review

Answer 24

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]).

Question 25

Caseload

Answer 25

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

Question 26

Clinical Pathway (See Case Management Plan)

Answer 26

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.

Question 27

Coding

Answer 27

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.

Question 28

Communication Skills

Answer 28

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.

Question 29

Consensus

Answer 29

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

Question 30

Continuous Quality Improvement (CQI)

Answer 30

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.

Question 31

Continuum of Care

Answer 31

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.

Question 32

Coordination

Answer 32

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

Question 33

Custodial Care

Answer 33

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

Question 34

Delay in Service

Answer 34

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

Question 35

Discharge Outcomes (criteria)

Answer 35

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.

Question 36

Discharge Planning

Answer 36

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.

Question 37

Discharge Status

Answer 37

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

Question 38

Disease Management

Answer 38

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.

Question 39

Effectiveness of Care

Answer 39

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.

Question 40

Efficacy of Care

Answer 40

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

Question 41

Efficiency of Care

Answer 41

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.

Question 42

First-Level Reviews

Answer 42

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

Question 43

Hospice

Answer 43

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.

Question 44

Implementation

Answer 44

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.

Question 45

Independent Case Management

Answer 45

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.

Question 46

Independent Living

Answer 46

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.

Question 47

Indicator

Answer 47

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.

Question 48

Injury

Answer 48

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.

Question 49

Integrated Delivery System (IDS)

Answer 49

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.

Question 50

Intensity of Service

Answer 50

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

Question 51

Intermediate Outcome

Answer 51

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.

Question 52

Intervention

Answer 52

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.

Question 53

Level of Care

Answer 53

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

Question 54

Levels of Service

Answer 54

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.

Question 55

License

Answer 55

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.

Question 56

Managed Competition

Answer 56

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.

Question 57

Management Service Organization

Answer 57

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.

Question 58

Medical Loss Ratio (MLR)

Answer 58

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

Question 59

Medical Necessity on Admission

Answer 59

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

Question 60

Medically Necessary

Answer 60

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

Question 61

Minimum Data Set (MDS)

Answer 61

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

Question 62

Monitoring

Answer 62

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.

Question 63

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

Answer 63

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.

Question 64

Nondisabling Injury

Answer 64

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

Question 65

Nursing Case Management | or Case Management.

Answer 65

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.

Question 66

Outcome

Answer 66

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.

Question 67

Outcome and Assessment Information Set (OASIS)

Answer 67

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).

Question 68

Outcome Indicators

Answer 68

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

Question 69

Outcomes Measurement

Answer 69

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

Question 70

Outcomes Monitoring

Answer 70

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.

Question 71

Outlier

Answer 71

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

Question 72

Outlier Threshold

Answer 72

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).

Question 73

Overutilization

Answer 73

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

Question 74

Partial Disability

Answer 74

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

Question 75

Performance Improvement

Answer 75

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.

Question 76

Physical Disability

Answer 76

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.

Question 77

Planning

Answer 77

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.

Question 78

Practice Guidelines (Guidelines)

Answer 78

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.

Question 79

Premature Discharge

Answer 79

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).

Question 80

Primary Care

Answer 80

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.

Question 81

Principal Diagnosis

Answer 81

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

Question 82

Principal Procedure

Answer 82

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.

Question 83

Prospective Review

Answer 83

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

Question 84

Protocol

Answer 84

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.

Question 85

Provider

Answer 85

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

Question 86

Quality Assurance

Answer 86

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.

Question 87

Quality Improvement

Answer 87

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.

Question 88

Quality Indicator

Answer 88

A predetermined measure for assessing quality; a metric.

Question 89

Quality Management

Answer 89

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.

Question 90

Quality Monitoring

Answer 90

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.

Question 91

Report Card

Answer 91

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.

Question 92

Resource Utilization Group (RUG)

Answer 92

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.

Question 93

Retrospective Review

Answer 93

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

Question 94

Treatment

Answer 94

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

Question 95

Variance

Answer 95

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.

Question 96

Outcomes Management

Answer 96

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

Question 97

Risk Management

Answer 97

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

Question 98

Root Cause Analysis

Answer 98

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.

Question 99

Second Opinion

Answer 99

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.

Question 100

Severity of Illness

Answer 100

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.

Question 101

Skilled Care

Answer 101

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.

Question 102

Social Work

Answer 102

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.

Question 103

Special Education

Answer 103

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.

Question 104

Subacute Care Facility

Answer 104

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.

Question 105

Telephone Triage

Answer 105

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.

Question 106

Telephonic Case Management

Answer 106

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.

Question 107

Transitional Planning

Answer 107

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.