Glossary of Accreditation Terminology
Components of diabetes self-management education (DSME/T) which include being active, healthy eating, taking medication, monitoring, problem solving, reducing risks and healthy coping
A voluntary process whereby a program of study or an institution is recognized by an external body as meeting certain predetermined standards. For facilities, accreditation standards are usually defined in terms of physical plant, governing body, administration, and medical and other staff. Accreditation is often carried out by independent, non-governmental organizations created for the purpose of assuring the public of the quality of the accredited institution or program. The State or Federal governments can recognize accreditation in lieu of, or as the basis for, licensure or other mandatory approvals. Public or private payment programs often require accreditation as a condition of payment for covered services. Accreditation may either be permanent or may be given for a specified period of time
Organizing and combining data such as outcomes so that it represents a sum or a whole
All types of health services that are provided on an outpatient basis, and that do not involve an overnight hospital stay, in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies that the patient must travel to a location to receive services that do not require an overnight stay. See also Ambulatory Setting and Outpatient
A place in which a DSME/T program is provided on an outpatient basis and that is available to
patients who are not bedridden. The patient usually travels to the ambulatory setting to
receive DSME/T services, which could be offered in clinician offices (large and small practices),
outpatient clinics, community health centers, pharmacies, and ambulatory surgery centers.
Some home care entities are included in this
Citation: click here
Gives civil rights protection to individuals with disabilities similar to those provided to individuals on the basis of race, color, sex, national origin, age, and religion. Disability, defined as a physical or mental impairment that substantially limits a major life activity, includes mobility, stamina, sight, hearing and speech, emotional illness and learning disorders. It guarantees equal opportunity for individuals with disabilities in public accommodations, employment, transportation, State and local government services, and telecommunications. ADA addresses access to the workplace (title I), State and local government services (title II) and places of public accommodation and commercial facilities (title III).
An individual, physician, or entity accredited by an approved organization as meeting one of the following sets of quality standards: 1) Furnishes other services for which direct Medicare payment may be made; 2) may properly receive Mediare payment under Title 42 CFR Sec. 424.73 or Sec. 424.80 of this chapter (Conditions for Medicare payment: Subpart F) which set forth prohibitions on assignment and reassignment of benefits; 3) Submits necessary documentation to, and is accredited by, an accreditation organization approved by CMS under Title 42 CFR Sec. 410.142 to meet one of the sets of quality standards described in Sec. 410.244; 4) Provides documentation to CMS, as requested, including diabetes outcome measurement set forth at Sec. 410.146.
The first step in diabetes education, which includes gathering information about the patient by reviewing the medical record and interviewing the patient and/or family or significant others to identify educational needs and barriers to self-management of diabetes and to plan an educational approach.
A process for establishing or confirming that something (or someone) like a signature is authentic. For example, a process that ensures that an electronic signature was produced by (or originated from or relayed by) the author.
Credential that demonstrates that the healthcare professional is able to perform a complete and/or focused assessment, recognize and prioritize complex data in order to identify needs of patients with diabetes across the life span and provide therapeutic problem solving, counseling and self-management training. This credential is jointly sponsored by the American Association of Diabetes Educators and the American Nurses Credentialing Center.
A planned change in behavior that is expected to result in improved health or quality of life; objectives that are chosen by the individual, for example, a person with diabetes. Characteristics of behavioral goals are that the participant values the goals, believes that changing the behavior will improve his/her health or quality of life and is likely to be successful in changing the behavior. For example, recording food intake and physical activity in a logbook for 4 days a week for one month.
A level of care set as a goal to be attained. Internal benchmarks are derived from similar processes or services within an organization. Competitive benchmarks are comparisons with the best external competitors in the field. Generic benchmarks are drawn from the best performance of similar processes in other industries.
A way or method of accomplishing a function or process that is considered to be superior to other known functions or processes. For example, A1C is considered a superior method of monitoring blood glucose over time.
A projected spending plan that takes into account revenue and expenses.
Plans for new ventures that integrate strategic, operational, and financial planning.
Health care professionals who possess the credentials that are required to sit for the CDE exam and are actively working toward completion of the practice requirements that must be met prior to taking the exam.
1)The process by which a governmental or non-governmental agency or association evaluates and recognizes an individual, institution or educational program as meeting predetermined standards. One so recognized is said to be "certified." It is essentially synonymous with accreditation, except that certification is usually applied to individuals, and accreditation institutions. Certification programs are generally non-governmental and do not exclude the uncertified from practice as do licensure programs. 2) CMS specific: Certification is a recommendation made by the State Agency (SA) on the compliance of providers & suppliers with the conditions of participation, requirements, &/or conditions of coverage. SAs officially certify the findings that health care entities meet the Act's provider or supplier definitions and comply with standards required by Federal regulations. SAs do not have Medicare determination making functions or authorities. However, SA certifications are crucial evidence relied upon by the Regional Offices (ROs) in approving health care entities to participate in Medicare & Clinical Laboratories Improvement Act (CLIA).
A health care professional with expertise in diabetes education who has met eligibility requirements and successfully completed a certification exam (See Diabetes Educator).
The CMS Manual System Department of Health & Human Services (DHHS) Pub 100-02 Medicare Benefit Policy states that a “certified provider” is a physician or other individual or entity designated by the Secretary that, in addition to providing outpatient self-management training services, provides other items and services for which payment may be made under title XVIII, and meets certain quality standards. The CMS is designating all providers and suppliers that bill Medicare for other individual services such as hospital outpatient departments, renal dialysis facilities, physicians and durable medical equipment suppliers as certified. All suppliers/providers who may bill for other Medicare services or items and who represent a DSME/T program that is accredited as meeting quality standards can bill and receive payment for the entire DSME/T program. Registered dietitians are eligible to bill on behalf of an entire DSME/T program on or after January 1, 2002, as long as the provider has obtained a Medicare provider number.
Equipment suppliers as certified, all suppliers/providers who may bill for other Medicare services or items and who represent a DSME/T program that is accredited as meeting quality standards can bill and receive payment for the entire DSME/T program.. Registered dietitians are eligible to bill on behalf of an entire DSME/T program on or after January 1, 2002, as long as the provider has obtained a Medicare provider number. A dietitian may not be the sole provider of the DSME/T service.
An out-patient medical establishment that provides health care services and medical treatment in a setting comprised of a variety of different health care providers, possibly including various medical specialists, who work together cooperatively. Discounted rates for services may or may not be available.
A measurable change in status of an individual as a result of health care services provided that reflects a change in disease condition/medical status. Also referred to as "post intermediate) outcome such as the following: A1c, BP, Lipids, weight, or the end result of achieving behavior change such as obtaining recommended monitoring exams, obtaining recommended consultations or smoking cessation.
To work jointly with others or together especially in an intellectual endeavor; to cooperate with an agency with which one is not immediately connected.
A formal notice of dissatisfaction. Also known as a grievance.
Conformity in fulfilling official requirements.
(CME) Formal education obtained by a health professional after education obtained by a health professional after completing his/her degree and full-time postgraduate training. For physicians, some States require CME (usually 50 hours per year) for continued licensure, as do some specialty boards for education.
(CQI) an iterative, planned process intended to improve the delivery of products or services with an emphasis on the organization and systems of an institution or industry.
The recognition of professional or technical competence. The credentialing process may include registration, certification, licensure, professional association membership, or the ward of a degree in the field. Certification and licensure affect the supply of health personnel by controlling entry into practice and influence the stability of the labor force by affecting geographic distribution, mobility, and retention of workers. Credentialing also determines the quality if personnel by providing standards for evaluating competence and by defining the scope of functions and how personnel may be used.
Medicare requires DSME/T programs to have a written curriculum that includes specified content areas relating to the patient’s understanding of self-management skills, knowledge and behavior change. The educational plan and comprehensive curriculum are based on the AADE7 and typically include a needs assessment, teaching techniques/tools, collaborative goal setting with implementation and criteria for assessing behavior change and goal achievement, and appropriate documentation.
Some States use the findings of private accreditation organizations, in part or in whole, to supplement or substitute for State oversight of some quality related standards. This is referred to as "deemed compliance" with a standard.
An individual, physician, or entity accredited by an approved organization, but that has not yet been approved by CMS to furnish and receive Medicare payment for DSME/T.
A health care professional who is credentialed to provide specialized clinical services for the treatment and management of diabetes. A diabetes clinical management specialist typically provides service that expands the traditional discipline specific practice and is able to 1) perform complete and/or focused assessments; 2) recognize and prioritize complex data in order to identify needs of patients with diabetes across the life span, and 3) provide therapeutic problem-solving, counseling, and regimen adjustments. The scope of the clinical management specialist may include the following skills: medication adjustment; medical nutrition therapy; exercise planning; counseling for behavior management, and psychosocial issues.
Community health workers—also known as community health advocates, lay health advisors, lay health educators, community health representatives, peer health promoters, community health outreach workers, and promoters de salud—are frontline public health workers who are a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy (6).
A health care professional who teaches people who have diabetes how to manage their diabetes. Some diabetes educators are certified diabetes educators (CDEs). Diabetes educators are found in hospitals, physician offices, managed care organizations, home health care, and other settings.
Diabetes education, also known as diabetes self-management training (DSME/T) or diabetes self-management education (DSME), is defined as a collaborative process through which people with or at risk for diabetes gain the knowledge and skills needed to modify behavior and successfully self-manage the disease and its related conditions.
DSME/T is an interactive, ongoing process involving the person with diabetes (or the caregiver or family) and a diabetes educator(s). The intervention aims to achieve optimal health status, better quality of life and reduce the need for costly health care
Diabetes education focuses on seven self-care behaviors that are essential for improved health status and greater quality of life.
The ongoing process of facilitating the knowledge, skill, and ability necessary for diabetes self-care. This process incorporates the needs, goals, and life experiences of the person with diabetes and is guided by evidence-based standards. The overall objectives of DSME are to support informed decision making, self-care behaviors, problem-solving and active collaboration with the health care team and to improve clinical outcomes, health status, and quality of life.
Important part of providing care for individuals with diabetes. Includes assessment, educational goals, behavioral change goals, interventions and outcomes. Documentation is necessary in diabetes education programs for reimbursement by third-party payers including individual or group health insurance, Medicare and Medicaid.
An individual who is responsible for oversight of the planning, implementation and evaluation of a diabetes self-management training/education program.
Selection of specific interventions, including educational content, and goals that meet individualized needs and that is based on a multifaceted assessment
Documentation that identifies the diabetes education process for each participant and includes: the assessment, education plan, educational interventions, evaluation and plan revision. The plan also identifies the dates of services and who provided them.
An important part of diabetes self-management education to monitor and evaluate outcomes and to reinforce and support behavior changes to achieve outcome goals.
A person who provides health care services, typically in exchange for payment, who possesses a
large body of knowledge derived from extensive academic study and formal training. A health
care professional is autonomous within their scope of practice and use independent judgment and
professional ethics in carrying out their responsibilities. Services are provided in
accordance with established protocols for licensing, ethics, procedures, standards of service and
training/certification. A health care professional or health care provider is an organization or
person who delivers proper health care in a systematic way professionally to any individual in need
of health care
Health care professionals include physicians, physician assistants, support staff, nurses, pharmacists, therapists, psychologists, veterinarians, dentists, chiropractors, physical therapists, optometrists, paramedics, and a wide variety of other individuals regulated and/or licensed to provide some type of health care.
1) An individual who provides health care services to consumers. Health care
providers are comprised of both professionals and non-professionals. A health care provider
or health professional is an organization or person who delivers proper health care in a systematic
way professionally to any individual in need of health care services. 2) In the context
of reimbursement, a "provider" refers to an individual or entity that is recognized by payers as
being eligible to receive payment for providing health care
Health care providers include physicians, physician assistants, support staff, nurses, pharmacists, therapists, psychologists, veterinarians, dentists, chiropractors, physical therapists, optometrists, paramedics, and a wide variety of other individuals regulated and/or licensed to provide some type of health care.
Different public and private agencies may have different definitions of a 'health disparity' for their own program-related purposes, but these definitions tend to have several things in common. In general, health disparities are defined as significant differences between one population and another. The Minority Health and Health Disparities Research and Education Act of 2000, which authorizes several HHS programs, describe these disparities as differences in "the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates." There are several factors that contribute to health disparities. Many different populations are affected by disparities including racial and ethnic minorities, residents of rural areas, women, children, the elderly, and persons with disabilities.
Someone who is admitted to a hospital or clinic for treatment that requires at least one overnight stay. Patients may receive diabetes care as hospital in-patients for acute illnesses or complications of diabetes.
This provides direction for persons who are going through the application process. The guidance serves to clarify and/or explain in simple terms the requirements for each quality standards.
Also educational objective. What the participant is expected to meet at the end of an educational session. For example, identify carbohydrate food sources
Administered, copyrighted, and published by the National Fire Protection Association (NFPA), the Life Safety Code, known as NFPA 101 is the registered trademark of an American consensus standard which, like many NFPA documents, is systematically revised on a three year cycle.
The standard, despite its title, is not a legal code, it is not published as an instrument of law and has no statutory authority unless adopted by the authority having jurisdiction. The standard, widely adopted in the United States, is however deliberately crafted with language suitable for mandatory application to facilitate adoption into law by those empowered to do so.
The bulk of the standard addresses "those construction, protection, and occupancy features necessary to minimize danger to life from fire, including smoke, fumes, or panic". The standard does not address the "general fire prevention or building construction features that are normally a function of fire prevention codes and building codes.
Evaluation of a health outcome indicator. Medicare’s coverage requirements for outpatient DSME/T
include outcome measurements for evaluating the improvement of the health status of Medicare
beneficiaries with diabetes and help to demonstrate that the DSME/T program meets designated
Citation: click here
(MNT) specific nutrition services provided to promote healthy eating for individuals with pre-diabetes and diabetes and include an in-depth nutrition assessment and nutrition counseling with a focus on achieving positive outcomes, for example normalizing A1C, serum lipids and blood pressure. The Registered Dietitian is the health professional trained to provide MNT.
A chronological written account of a patient's examination and treatment that includes the patient's medical history and complaints, the physician's physical findings, the results of diagnostic tests and procedures, and medications and therapeutic procedures.
A mission statement is a brief description of a company’s fundamental purpose. A mission statement answers the question, “Why do we exist?”
The mission statement articulates the company’s purpose both for those in the organization and for the public.
A group of health care professionals from a variety of disciplines who come together to provide comprehensive diabetes self-management care and education/training to people with or at risk of diabetes.
(NPI) the Administrative Simplification provisions of the U.S. federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of a standard unique identifier for health care providers. The National Plan and Provider Enumeration System (NPPES) collect identifying information on health care providers and assign each a unique National Provider Identifier (NPI). The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPI replaces PIN (Provider Identification Number). Health care providers can access an application for a NPI from the CMS webpage.
A graphic depiction of formal relationships within the organization that identifies areas of responsibility, accountability relationships and channels of communication.
Design of an organization through which the enterprise is administered. The design of an organization facilitates the performance of work and the flow of information.
A measurable change in the state or condition of an individual as a consequence of health care service and/or intervention/s provided. Refers to the "outcome" (finding) of a given diagnostic procedure. It may also refer to cure of the patient, restoration of function, or extension of life. When used for populations or the health care systems, it typically refers to changes in birth or death rates, or some similar global measure.
Barriers: Factors that interfere with disease self-management, for example, stress, lack of social support, environmental factors such as unavailability of grocery stores or parks in the neighborhood.
Identification of : Determining which measures to monitor for example, in a DSME program or in an outpatient setting; may include clinical outcomes and/or processes such as frequency of eye exams or foot exams.
Measure: A number assigned to an object or an event. Measures can be expressed in several different ways: counts (20 visits), rates (20 visits/day), proportions (20 primary healthcare visits/400 total visits = 0.050, percentage (5% of the visits made), or ratios (20 visits/4 health workers = 5).
Skills in managing diabetes: Skills needed to manage blood glucose and prevent acute and chronic complications and includes counting carbohydrates, adjusting diet and/or medications on sick days to manage blood glucose, adjusting diet with changes in physical activity.
A patient who receives treatment at a hospital, for example, in the emergency room or clinic, but is not hospitalized. The majority of diabetes education is delivered in an out-patient setting.
Education and self-management support provided by people who also have diabetes and/or who share other relevant, similar characteristics such as another chronic illness.
A process to quantify an outcome indicator that reflects the effective execution or accomplishment of important functions and processes related to health care.
An out-patient setting in which medical consultation and treatment are provided by a relatively limited number of physician providers who are typically comprised of the same specialty.
The development of program goals and objectives for operational maintenance or for quality improvement.
At or near the site where the patient care and/or DSME/T is provided.
A governing plan for accomplishing goals and objectives.
An assessment of a DSME/T program participant's status at a specified time frame/s following completion of education planned. The assessment includes behavior change goal achievement, general health status and follow-through with any specific recommendations or referrals.
The "medical home" for a patient, ideally providing continuity and integration of health care. All family physicians and most pediatricians and internists are in primary care. The aims of primary care are to provide the patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.
A course of action undertaken by a diabetes educator in relation to DSME/T that is intended to achieve a specific behavior goal, behavior change or clinical outcome.
Refers to skills and knowledge attained for both personal development and career advancement. Professional development encompasses all types of facilitated learning opportunities, ranging from college degrees to formal coursework, conferences and informal learning opportunities situated in practice. It has been described as intensive and collaborative, ideally incorporating an evaluative stage. There are a variety of approaches to professional development, including consultation, coaching, communities of practice, lesson study, mentoring, reflective supervision and technical assistance.
A periodic or ad hoc assessment or study that is conducted systematically to assess how well the program outcomes are meeting the target and overall program objectives.
Components of a DSME/T program infrastructure that are necessary to provide quality services such as: personnel, space, teaching aides, office supplies, audio-visual equipment, etc.
A health care professional who is either a CDE or is eligible to become one and who obtains and/or maintains expertise in diabetes care and education by obtaining at least 6 continuing education contact hours in diabetes topics annually.
Non-physician health care providers recognized by CMS as eligible for reimbursement for covered services (typically a physician assistance and a nurse practitioner).
The degree of well-being felt by an individual. It consists of two components: physical and psychological. The physical aspect includes things such as health, diet, and protection against pain and disease. The psychological aspect includes stress, worry, pleasure and other positive or negative emotional states. It is virtually impossible to predict the quality of life of a specific individual, since the combination of attributes that leads one individual to be content is rarely the same for another individual.
An alternate location where diabetes education services are provided.
The entity that is financially responsible for a DSME/T program.
Interested parties that can be directly or indirectly affected by the actions, mission, values and goals of the organization. Stakeholders can represent a variety of groups from customers to suppliers, owners to community members. Stakeholders can be identified by the organization or self-identified and not all stakeholders are equal. Different types of stakeholders may need special considerations depending on the need of the group and availability of resources of the organization.
Expectations about structure, processes and/or outcomes that are typically related to accreditation and/or certification processes.
A description of any relevant characteristics (diabetes type, geographic location, ethnicity, etc) that the DSME/T program intends to serve.
The delivery of health related services and information via telecommunications technologies. Telecommunication includes telephone voice communication, text messaging, computer use and videoconferencing.
The delivery of health related services and information via telecommunications technologies. Telecommunication includes telephone voice communication, text messaging, computer use and videoconferencing.
A mental image of what an organization imagines it can accomplish.