CPHQ Glossary

Key healthcare quality terms for the CPHQ exam.

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

A

Accountable Care Organization (ACO): A group of healthcare providers who voluntarily coordinate care to improve quality and reduce costs for a defined patient population.
Adverse Event: An injury caused by medical management rather than the underlying disease or condition of the patient.

B

Balanced Scorecard: A strategic planning framework that measures performance across four perspectives: financial, customer, internal processes, and learning/growth.
Benchmarking: The process of comparing an organization's performance metrics to best practices or standards from other organizations or industries.

C

CAHPS: Consumer Assessment of Healthcare Providers and Systems. Standardized surveys for measuring patient experience with healthcare.
CAUTI: Catheter-Associated Urinary Tract Infection. A HAI associated with urinary catheter use.
CLABSI: Central Line-Associated Bloodstream Infection. A serious HAI associated with central venous catheters.
CMS: Centers for Medicare and Medicaid Services. Federal agency that administers Medicare and Medicaid programs and sets Conditions of Participation for hospitals.
Common Cause Variation: Natural, inherent variation in a process that is stable and predictable. Addressed through fundamental process redesign, not individual investigation.
Conditions of Participation (CoPs): Federal requirements that healthcare organizations must meet to participate in Medicare and Medicaid programs.
Control Chart: A statistical tool that plots data over time with upper and lower control limits to distinguish between common cause and special cause variation.
Credentialing: The process of verifying a healthcare practitioner's qualifications, including education, training, licensure, and work history.

D

Deemed Status: Recognition by CMS that accreditation by an approved accrediting body (such as The Joint Commission) is equivalent to meeting CMS Conditions of Participation.
DMAIC: Define, Measure, Analyze, Improve, Control. The core methodology of Six Sigma for improving existing processes.
DNV GL: An accrediting body for hospitals that integrates ISO 9001 quality management system requirements with CMS Conditions of Participation.
Donabedian Model: A framework for evaluating healthcare quality through three components: structure (resources), process (what is done), and outcomes (results).

E

Evidence-Based Practice: Clinical decision-making that integrates the best available research evidence with clinical expertise and patient values.

F

Failure Mode and Effects Analysis (FMEA): A proactive risk assessment tool that identifies potential failure modes in a process, assesses their severity, likelihood, and detectability, and prioritizes actions to prevent them.
Fishbone Diagram: Also called Ishikawa or cause-and-effect diagram. A visual tool for identifying and organizing potential causes of a problem into categories.
Flowchart: A visual representation of the steps in a process, showing the sequence and decision points.
FPPE: Focused Professional Practice Evaluation. A time-limited, focused evaluation of a practitioner triggered by new privileges, concerns, or performance issues.

H

HAC: Hospital-Acquired Condition. A condition that was not present on admission and for which CMS may reduce payment.
HAI: Healthcare-Associated Infection. An infection acquired during the course of receiving healthcare treatment.
HCAHPS: Hospital Consumer Assessment of Healthcare Providers and Systems. A standardized survey measuring patient perspectives on hospital care.
Health Disparities: Differences in health outcomes and their determinants between segments of the population, often linked to social, economic, or environmental disadvantages.
Health Equity: The state in which everyone has a fair and just opportunity to attain their highest level of health.
HEDIS: Healthcare Effectiveness Data and Information Set. A set of performance measures used by NCQA to evaluate health plan quality.
High Reliability Organization (HRO): An organization that operates in complex, high-hazard domains while maintaining exceptionally safe performance. Characterized by preoccupation with failure, sensitivity to operations, reluctance to simplify, commitment to resilience, and deference to expertise.
Histogram: A bar chart that displays the frequency distribution of continuous data, showing the shape, center, and spread of the data.

I

Incidence: The number of new cases of a disease or condition occurring in a population during a specified time period.
InterQual: A proprietary clinical decision support tool used for utilization management, providing evidence-based criteria for admission, continued stay, and discharge.
ISO 9001: International quality management system standard. Used by DNV GL as part of its hospital accreditation program.

J

Joint Commission: An independent accrediting body for healthcare organizations. Accreditation provides deemed status for CMS Conditions of Participation.
Just Culture: A system of shared accountability where organizations are accountable for the systems they design and individuals are accountable for the quality of their choices.

K

Kaizen: A Lean methodology term meaning continuous improvement through small, incremental changes.
Key Performance Indicator (KPI): A measurable value that demonstrates how effectively an organization is achieving key objectives.

L

Lean: A methodology focused on maximizing value while minimizing waste. In healthcare, it aims to eliminate activities that do not add value to patient care.

M

Mean: The arithmetic average of a set of values. Sum of all values divided by the number of values.
Median: The middle value in a dataset when arranged in order. Less affected by outliers than the mean.
Mode: The most frequently occurring value in a dataset.

N

NCQA: National Committee for Quality Assurance. An organization that accredits health plans and uses HEDIS measures to evaluate performance.
Near Miss: An event or situation that could have resulted in an adverse event but did not, either by chance or timely intervention.
Never Event: Serious, largely preventable patient safety incidents that should never occur, such as wrong-site surgery.
NQF: National Quality Forum. A consensus-based organization that endorses healthcare quality measures and practices.

O

OPPE: Ongoing Professional Practice Evaluation. A periodic, data-driven evaluation of all medical staff members to identify performance trends.
Outcome Measure: A metric that reflects the results of healthcare processes, such as mortality rates, infection rates, or readmission rates.

P

Pareto Chart: A bar chart that arranges causes in descending order of frequency with a cumulative percentage line. Based on the 80/20 principle.
Patient-Centered Medical Home (PCMH): A model of care delivery that emphasizes comprehensive, coordinated, patient-centered primary care.
PDSA Cycle: Plan-Do-Study-Act. An iterative quality improvement methodology that tests changes on a small scale before broader implementation.
Peer Review: Evaluation of a healthcare practitioner's professional performance by colleagues with similar qualifications and expertise.
Prevalence: The total number of existing cases of a disease or condition in a population at a specific point in time.
Privileging: The process of granting a healthcare practitioner permission to provide specific patient care services based on their credentials and competence.
Process Measure: A metric that reflects what is done to or for a patient, such as medication administration or screening completion rates.

Q

QAPI: Quality Assessment and Performance Improvement. A CMS-required program for healthcare organizations to maintain and improve quality.

R

Risk Adjustment: Statistical methods used to account for differences in patient severity and case mix when comparing outcomes across organizations.
Root Cause Analysis (RCA): A systematic investigation process used after a serious adverse event to identify the fundamental, underlying causes and develop corrective actions.
Run Chart: A line graph that displays data points over time against a median line. Used to detect trends, shifts, and patterns in a process.

S

Scatter Diagram: A graph that plots two variables against each other to identify potential relationships or correlations.
Sentinel Event: An unexpected occurrence involving death or serious physical or psychological injury. Requires root cause analysis.
Six Sigma: A data-driven methodology for reducing defects and variation. Aims for no more than 3.4 defects per million opportunities.
Social Determinants of Health (SDOH): Conditions in the environments where people are born, live, learn, work, and age that affect health outcomes. Includes economic stability, education, social context, healthcare access, and neighborhood.
Special Cause Variation: Unusual, non-random variation in a process caused by specific, identifiable factors. Requires investigation to identify and address the root cause.
SSI: Surgical Site Infection. An infection that occurs at or near the surgical incision within a specified time period after surgery.
Standard Deviation: A measure of the amount of variation or dispersion in a set of values from the mean.
Structure Measure: A metric that reflects the organizational resources and systems in place, such as staffing ratios, equipment availability, or policy existence.
Swiss Cheese Model: James Reason's model illustrating how multiple layers of defense have weaknesses (holes), and an adverse event occurs when holes align across all layers.

T

Tracer Methodology: A survey technique used by The Joint Commission that follows individual patients through the care process to evaluate compliance with standards.
Transformational Leadership: A leadership style that inspires and motivates followers to achieve extraordinary outcomes by creating a vision and fostering innovation and change.
Triple Aim: Framework developed by IHI with three goals: improving patient experience, improving population health, and reducing per capita cost of healthcare.

U

Utilization Management: The evaluation of the medical necessity, appropriateness, and efficiency of healthcare services through pre-authorization, concurrent review, and retrospective review.

V

Value Stream Mapping: A Lean tool that visually maps all steps in a process, distinguishing between value-adding and non-value-adding activities.
VTE: Venous Thromboembolism. Includes deep vein thrombosis and pulmonary embolism. A focus of hospital prevention programs.

W

Western Electric Rules: A set of decision rules for detecting special cause variation in control charts, including points beyond control limits, runs, and trends.