Navigating Healthcare Systems
Expert-defined terms from the Professional Certificate in Patient Advocacy (Part II) course at LearnUNI. Free to read, free to share, paired with a professional course.
Accountable Care Organization (ACO) refers to a network of healthcare providers… #
Related terms include Healthcare System, Patient-Centered Medical Home, and Value-Based Care. ACOs aim to improve patient outcomes, reduce healthcare costs, and enhance the overall patient experience. For example, an ACO may implement a care coordination program to ensure that patients receive seamless care across different healthcare settings.
Administrative Simplification refers to the process of streamlining administrati… #
Related terms include Health Insurance Portability and Accountability Act (HIPAA), Electronic Health Records (EHRs), and Healthcare Information Technology. Administrative simplification can help reduce administrative burdens on healthcare providers, allowing them to focus on patient care.
Adverse Event refers to an unexpected or unfavorable medical occurrence t… #
Related terms include Patient Safety, Medical Error, and Near Miss. Adverse events can be caused by a variety of factors, including medication errors, surgical complications, or hospital-acquired infections. For example, a patient may experience an adverse event due to a medication interaction that was not properly monitored.
Advocacy refers to the act of supporting or promoting the rights and inte… #
Related terms include Patient Advocacy, Healthcare Navigation, and Health Literacy. Advocacy can involve a range of activities, from providing emotional support to patients and families to advocating for policy changes that promote healthcare access and equity.
Ambulatory Care refers to medical care provided on an outpatient basis, such as… #
Related terms include Primary Care, Specialty Care, and Telehealth. Ambulatory care can include a range of services, from routine check-ups and vaccinations to diagnostic testing and treatment for chronic conditions.
Benefit Design refers to the process of creating and structuring health insuranc… #
Related terms include Health Insurance, Plan Design, and Network Management. Benefit design can involve a range of considerations, including the types of services covered, the level of cost-sharing, and the network of participating providers.
Care Coordination refers to the process of organizing and managing patient care… #
Related terms include Care Management, Case Management, and Transition Management. Care coordination can help ensure that patients receive seamless care, reduce the risk of medical errors, and improve overall health outcomes.
Care Transition refers to the process of transferring a patient from one care… #
Related terms include Care Coordination, Discharge Planning, and Readmission Reduction. Care transitions can be complex and require careful planning to ensure that patients receive continuous, high-quality care.
Chronic Care Management refers to the process of coordinating and managing care… #
Related terms include Care Coordination, Disease Management, and Population Health Management. Chronic care management can involve a range of activities, from medication management and monitoring to patient education and support.
Clinical Decision Support (CDS) refers to the use of computer systems to… #
Related terms include Electronic Health Records (EHRs), Health Information Technology, and Medical Informatics. CDS can help improve the quality and safety of care by reducing the risk of medical errors and promoting evidence-based practice.
Commission on Accreditation of Rehabilitation Facilities (CARF) refers to a n… #
Related terms include Accreditation, Certification, and Quality Improvement. CARF accreditation can help ensure that rehabilitation facilities and programs meet certain standards for quality and safety.
Community Health refers to the health and well #
being of a community or population, including the social and environmental factors that influence health. Related terms include Public Health, Population Health, and Health Promotion. Community health can involve a range of activities, from health education and outreach to policy development and advocacy.
Comorbidity refers to the presence of one or more additional health condi… #
Related terms include Chronic Care Management, Disease Management, and Patient Complexity. Comorbidity can increase the complexity of patient care and require specialized management and coordination.
Compliance refers to the process of adhering to regulatory requirements a… #
Related terms include Regulatory Compliance, Accreditation, and Quality Improvement. Compliance can help ensure that healthcare providers meet certain standards for quality, safety, and patient care.
Consumer #
Directed Healthcare refers to a model of healthcare in which patients take a more active role in making decisions about their care, including the use of health savings accounts and other financial incentives. Related terms include Patient-Centered Care, Shared Decision-Making, and Health Literacy. Consumer-directed healthcare can help promote patient engagement and empowerment.
Continuity of Care refers to the process of ensuring that patients receive co… #
Related terms include Care Coordination, Care Transition, and Patient-Centered Care. Continuity of care can help ensure that patients receive seamless care and reduce the risk of medical errors.
Co #
Payment refers to a fixed amount that patients pay out-of-pocket for a specific healthcare service, such as a doctor's visit or prescription medication. Related terms include Cost-Sharing, Deductible, and Coinsurance. Co-payments can help reduce the financial burden of healthcare on patients.
Cost Containment refers to the process of reducing or controlling healthcare<… #
Related terms include Cost-Sharing, Utilization Review, and Healthcare Reform. Cost containment can help reduce the financial burden of healthcare on patients and the healthcare system as a whole.
Cost #
Sharing refers to the process of dividing the costs of healthcare between patients and healthcare providers or payers, such as through co-payments, deductibles, or coinsurance. Related terms include Co-Payment, Deductible, and Coinsurance. Cost-sharing can help reduce the financial burden of healthcare on patients and promote more efficient use of healthcare resources.
Critical Care refers to the provision of intensive medical care for patie… #
Related terms include Intensive Care Unit, Critical Care Medicine, and Life Support. Critical care can involve a range of specialized services, from mechanical ventilation to cardiac monitoring.
Cultural Competence refers to the ability of healthcare providers to unde… #
Related terms include Cultural Sensitivity, Health Disparities, and Patient-Centered Care. Cultural competence can help promote patient engagement, improve health outcomes, and reduce health disparities.
Deductible refers to the amount that patients must pay out #
of-pocket for healthcare expenses before insurance coverage kicks in. Related terms include Co-Payment, Coinsurance, and Cost-Sharing. Deductibles can help reduce the financial burden of healthcare on patients and promote more efficient use of healthcare resources.
Disease Management refers to the process of coordinating and managing care for p… #
Related terms include Chronic Care Management, Care Coordination, and Population Health Management. Disease management can involve a range of activities, from medication management and monitoring to patient education and support.
Discharge Planning refers to the process of planning and coordinating a patient'… #
Related terms include Care Transition, Care Coordination, and Readmission Reduction. Discharge planning can help ensure that patients receive continuous, high-quality care and reduce the risk of readmission.
Electronic Health Record (EHR) refers to a digital version of a patient's… #
Related terms include Health Information Technology, Medical Informatics, and Clinical Decision Support. EHRs can help improve the quality and safety of care by reducing the risk of medical errors and promoting evidence-based practice.
Emergency Medical Services (EMS) refers to the provision of emergency med… #
Related terms include Emergency Department, Trauma Care, and Disaster Response. EMS can involve a range of specialized services, from cardiac arrest management to trauma care.
Evidence #
Based Practice refers to the use of scientific evidence to guide healthcare decisions and practices, such as the use of clinical guidelines and research studies. Related terms include Clinical Decision Support, Health Services Research, and Quality Improvement. Evidence-based practice can help improve the quality and safety of care by reducing the risk of medical errors and promoting effective treatments.
Health Coaching refers to the process of educating and supporting patients to <b… #
Related terms include Patient Education, Health Promotion, and Disease Management. Health coaching can help promote patient engagement, improve health outcomes, and reduce healthcare costs.
Health Disparities refer to the unequal distribution of health and health… #
Related terms include Health Equity, Cultural Competence, and Social Determinants of Health. Health disparities can be influenced by a range of factors, including socioeconomic status, education, and environmental conditions.
Health Informatics refers to the use of information technology to improve… #
Related terms include Health Information Technology, Medical Informatics, and Clinical Decision Support. Health informatics can help improve the quality and safety of care by reducing the risk of medical errors and promoting evidence-based practice.
Health Insurance refers to a type of insurance that provides financial pr… #
Related terms include Health Benefits, Insurance Plan, and Coverage. Health insurance can help reduce the financial burden of healthcare on patients and promote access to care.
Health Maintenance Organization (HMO) refers to a type of health insuranc… #
Related terms include Managed Care, Health Insurance, and Network Management. HMOs can help promote preventive care, reduce healthcare costs, and improve health outcomes.
Health Promotion refers to the process of promoting healthy behaviors and… #
Related terms include Health Education, Disease Prevention, and Wellness. Health promotion can help reduce the risk of chronic diseases, improve health outcomes, and enhance overall well-being.
Health Savings Account (HSA) refers to a type of savings account that all… #
Related terms include Health Reimbursement Arrangement (HRA), Flexible Spending Account (FSA), and Consumer-Directed Healthcare. HSAs can help promote patient engagement, reduce healthcare costs, and increase access to care.
Home Health Care refers to the provision of medical care and support serv… #
Related terms include Home Care, Hospice Care, and Palliative Care. Home health care can help promote patient comfort, reduce healthcare costs, and improve health outcomes.
Hospice Care refers to the provision of comfort care and support services… #
Related terms include Palliative Care, End-of-Life Care, and Hospice Services. Hospice care can help promote patient comfort, reduce suffering, and improve quality of life.
Hospital #
Acquired Condition (HAC) refers to a medical condition that a patient develops during a hospital stay, such as a hospital-acquired infection or pressure ulcer. Related terms include Patient Safety, Medical Error, and Quality Improvement. HACs can be prevented through a range of strategies, including infection control, fall prevention, and wound care.
Inpatient Care refers to the provision of medical care to patients who ar… #
Related terms include Hospital Care, Acute Care, and Intensive Care. Inpatient care can involve a range of specialized services, from surgery and anesthesia to critical care and rehabilitation.
Intensive Care Unit (ICU) refers to a specialized unit within a hospital… #
Related terms include Critical Care, Life Support, and Ventilator Care. ICUs can involve a range of specialized services, from mechanical ventilation to cardiac monitoring.
Interdisciplinary Care refers to the collaboration and coordination of care amon… #
Related terms include Team-Based Care, Collaborative Care, and Patient-Centered Care. Interdisciplinary care can help promote patient engagement, improve health outcomes, and reduce healthcare costs.
Managed Care refers to a type of health insurance plan that provides comp… #
Related terms include Health Insurance, Network Management, and Utilization Review. Managed care can help promote preventive care, reduce healthcare costs, and improve health outcomes.
Medical Error refers to an unintended or unexpected event that results in… #
Related terms include Patient Safety, Adverse Event, and Near Miss. Medical errors can be prevented through a range of strategies, including safety protocols, checklists, and teamwork training.
Medical Home refers to a model of primary care that emphasizes patient #
centered, coordinated, and comprehensive care, such as through patient-centered medical homes (PCMHs). Related terms include Primary Care, Patient-Centered Care, and Care Coordination. Medical homes can help promote patient engagement, improve health outcomes, and reduce healthcare costs.
Medication Management refers to the process of monitoring and managing a… #
Related terms include Pharmacy Care, Medication Reconciliation, and Adherence. Medication management can help reduce the risk of medication errors, improve health outcomes, and enhance patient safety.
Mental Health refers to a patient's emotional and psychological well #
being, including the diagnosis and treatment of mental health conditions such as depression and anxiety. Related terms include Behavioral Health, Mental Illness, and Substance Abuse. Mental health can be influenced by a range of factors, including genetics, environment, and lifestyle.
Network Management refers to the process of managing and coordinating a n… #
Related terms include Managed Care, Health Insurance, and Utilization Review. Network management can help promote access to care, reduce healthcare costs, and improve health outcomes.
Near Miss refers to an event that could have resulted in harm or injury to a pat… #
Related terms include Medical Error, Adverse Event, and Patient Safety. Near misses can provide opportunities for learning and improvement, such as through root cause analysis and safety protocols.
Outpatient Care refers to the provision of medical care to patients on an… #
Related terms include Ambulatory Care, Primary Care, and Specialty Care. Outpatient care can involve a range of services, from routine check-ups and vaccinations to diagnostic testing and treatment for chronic conditions.
Palliative Care refers to the provision of comfort care and support servi… #
Related terms include Hospice Care, End-of-Life Care, and Symptom Management. Palliative care can help promote patient comfort, reduce suffering, and improve quality of life.
Patient Advocacy refers to the process of supporting and promoting the ri… #
Related terms include Patient-Centered Care, Patient Engagement, and Health Literacy. Patient advocacy can help promote patient autonomy, improve health outcomes, and reduce healthcare costs.
Patient #
Centered Care refers to a model of care that emphasizes patient-centered, coordinated, and comprehensive care, such as through patient-centered medical homes (PCMHs). Related terms include Medical Home, Care Coordination, and Patient Engagement. Patient-centered care can help promote patient engagement, improve health outcomes, and reduce healthcare costs.
Patient Engagement refers to the process of empowering patients to take a… #
Related terms include Patient-Centered Care, Health Literacy, and Patient Advocacy. Patient engagement can help promote patient autonomy, improve health outcomes, and reduce healthcare costs.
Patient Safety refers to the process of reducing the risk of harm or inju… #
Related terms include Medical Error, Adverse Event, and Near Miss. Patient safety can be promoted through a range of strategies, including safety culture, risk management, and performance improvement.
Pay #
for-Performance (P4P) refers to a payment model that rewards healthcare providers for meeting certain performance standards, such as through quality metrics or patient satisfaction scores. Related terms include Value-Based Care, Quality Improvement, and Performance Incentives. P4P can help promote quality improvement, reduce healthcare costs, and improve health outcomes.
Pharmacy Care refers to the provision of pharmaceutical services to patie… #
Related terms include Medication Management, Medication Reconciliation, and Adherence. Pharmacy care can help reduce the risk of medication errors, improve health outcomes, and enhance patient safety.
Population Health Management refers to the process of managing and improv… #
Related terms include Public Health, Community Health, and Health Promotion. Population health management can help promote health equity, reduce health disparities, and improve health outcomes.
Preventive Care refers to the provision of preventive services and interv… #
Related terms include Health Promotion, Disease Prevention, and Wellness. Preventive care can help reduce the risk of chronic diseases, improve health outcomes, and enhance overall well-being.
Primary Care refers to the provision of first #
line medical care to patients, such as through primary care physicians (PCPs) and primary care clinics. Related terms include Ambulatory Care, Outpatient Care, and Medical Home. Primary care can involve a range of services, from routine check-ups and vaccinations to diagnostic testing and treatment for chronic conditions.
Quality Improvement (QI) refers to the process of improving the quality a… #
Related terms include Patient Safety, Medical Error, and Performance Improvement. QI can help promote quality improvement, reduce healthcare costs, and improve health outcomes.
Readmission Reduction refers to the process of reducing the rate of hospi… #
Related terms include Care Transition, Care Coordination, and Hospital Readmission. Readmission reduction can help improve patient outcomes, reduce healthcare costs, and enhance patient safety.
Rehabilitation Care refers to the provision of rehabilitative services to… #
Related terms include Physical Therapy, Occupational Therapy, and Speech Therapy. Rehabilitation care can help promote patient recovery, improve functional outcomes, and enhance quality of life.
Risk Management refers to the process of identifying and mitigating risks… #
Related terms include Patient Safety, Medical Error, and Quality Improvement. Risk management can help reduce the risk of adverse events, improve patient outcomes, and enhance patient safety.
Social Determinants of Health (SDOH) refer to the social and environmenta… #
Related terms include Health Disparities, Health Equity, and Population Health Management. SDOH can help promote health equity, reduce health disparities, and improve health outcomes.
Specialty Care refers to the provision of specialized medical care to pat… #
Related terms include Ambulatory Care, Outpatient Care, and Referral Management. Specialty care can involve a range of services, from diagnostic testing and treatment for chronic conditions to surgical interventions and rehabilitation.
Telehealth refers to the use of telecommunications technology to deliver… #
Related terms include Telemedicine, Remote Monitoring, and Virtual Care. Telehealth can help promote access to care, reduce healthcare costs, and improve health outcomes.
Transition Management refers to the process of coordinating and managing… #
Related terms include Care Coordination, Discharge Planning, and Readmission Reduction. Transition management can help ensure that patients receive continuous, high-quality care and reduce the risk of readmission.
Utilization Review (UR) refers to the process of reviewing and managing h… #
Related terms include Managed Care, Health Insurance, and Network Management. UR can help promote efficient use of healthcare resources, reduce healthcare costs, and improve health outcomes.
Value #
Based Care (VBC) refers to a model of care that emphasizes value, quality, and outcomes, such as through value-based payment models and performance incentives. Related terms include Pay-for-Performance, Quality Improvement, and Population Health Management. VBC can help promote quality improvement, reduce healthcare costs, and improve health outcomes.
Value #
Based Payment (VBP) refers to a payment model that rewards healthcare providers for delivering high-quality, cost-effective care, such as through value-based payment models and performance incentives. Related terms include Pay-for-Performance, Quality Improvement, and Population Health Management. VBP can help promote quality improvement, reduce healthcare costs, and improve health outcomes.
Wellness refers to the promotion of healthy behaviors and lifestyles, suc… #
Related terms include Health Promotion, Disease Prevention, and Population Health Management. Wellness can help reduce the risk of chronic diseases, improve health outcomes, and enhance overall well-being.