Berwick, Donald, MD, MPP: President and CEO of the Institute for Health Care Improvement (IHI) and Clinical Professor of Pediatrics and Health Care Policy at the Harvard Medical School; a recognized expert and published author on subjects relating to health care policy, decision analysis, technology assessment, and health care quality measurement. Top of page

Codman, Ernest A., MD: A physician regarded in health care as the "father of outcomes measurement;" he sought to establish an "end results system" to track and publicize the outcomes of patient treatments in order to identify opportunities for improving care and helping patients choose physicians and hospitals. Top of page

Deming, W. Edwards, PhD: (1900-1993) An American statistician and quality-control expert who used statistics to examine industrial production processes for flaws; he believed that improving product quality depended on increased management-labor cooperation as well as improved design and production processes. Top of page

Donabedian, Avedis, MD, MPH: Professor Emeritus of Public Health at the University of Michigan; the founder of the field of health care quality assurance who offered the categories of "structure," "process," and "outcome" as the three potential targets of the assessment of care. Top of page

Evidence-based medicine: Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Top of page

Fishbone diagram: The fishbone diagram, or cause-and-effect diagram, is a tool for capturing, displaying, and classifying the various theories about the causes of a problem. Top of page

Flow chart or flow diagram: A diagram that depicts the sequence of steps or events in a process. Top of page

Functional health status: Refers to a patient’s ability to perform typical daily physical and social/role functions, plus other measures of self-perceived health status such as well-being, vitality and mental health. Top of page

Health Plan Employer Data and Information Set (HEDIS): A set of performance measures designed to help employers and other purchasers of health care standardize information and compare health plans. The performance measures cover the areas of quality, access, patient satisfaction, membership, utilization and finance. HEDIS was initially developed in 1991 by the National Committee for Quality Assurance. Top of page

Histogram: A bar chart representing a frequency distribution; heights of the bars represent observed frequencies. Top of page

Human errors: Examples of human errors are transposing a number or misreading a prescription. Top of page

National Committee for Quality Assurance (NCQA): A nonprofit organization devoted to assessing and reporting on the quality of managed care plans. NCQA was formed in 1979 by the managed care industry and became independent in 1990. NCQA review is voluntary for health plans, but most plans seek its accreditation. The object of NCQA review and accreditation is to provide information to purchasers and patients and to encourage plans to compete based on quality and value rather than solely on price and provider network. Top of page

Outcome: The valued results of care as experienced primarily by the patient but also by physicians and all other participants in the processes contributing to the outcomes. Top of page

Pareto diagram: A diagram in which bars reflect the frequency of impact of problems and are arranged in order of height, from left to right, to identify the relative importance of categories. Top of page

Performance gap: The performance gap refers to the fact that, despite the accumulation of excellent scientific evidence to support many clinical interventions and the acceptance of benchmark targets for prevention services, clinicians’ performance with regard to implementing the evidence falls short of the mark. Top of page

Process: A sequence of tasks or interactions required to provide a product or service, including both technical and interpersonal processes. Top of page

Quality: Quality is, according to the Institute of Medicine (IOM), the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Top of page

Quality assurance or quality management (QA, QM): An internal review process that audits the quality of care delivered and implements corrective actions to remedy any deficiencies identified in the quality of direct patient care, administrative services or support services. The process can employ peer review, outcomes assessment, and utilization management techniques to assess and improve the quality of care. The level of care may be measured against preestablished standards. Top of page

Quality Improvement (QI): QI is a management technique to assess and improve internal operations. QI focuses on organizational systems rather than individual performance and seeks to continuously improve quality rather than reacting when certain baseline statistical thresholds are crossed. The process involves setting goals, implementing systematic changes, measuring outcomes, and making subsequent appropriate improvements. Top of page

Structure: The resources assembled to deliver care, including personnel, facilities and materials. Top of page

Total Quality Management: Total Quality Management (TQM) was developed by Joseph Juran. He identified required system elements to measure, design, and select processes that consistently deliver superior outcomes. These fundamentals make up the basis for TQM. Top of page

Wennberg, John, MD, MPH: Director of the Center for Evaluative Clinical Sciences at the Dartmouth Medical School. A physician who developed a strategy for studying the population-based rates of health resource allocation and utilization (small area analysis). The findings were published in the Dartmouth Atlas of Health Care. Top of page