Appendix B
Glossary

Ambulatory care In this report, ambulatory care refers to the outpatient care setting.

Cachexia Loss of fat-free mass, especially body cell mass, with little or no weight loss. The metabolic hallmarks of cachexia are hypermetabolism and hypercatabolism, driven by inflammatory cytokine-mediated acute phase responses.

Capitation A per-member monthly payment to a provider that covers contracted services to health management organization members and is paid in advance. A provider agrees to provide specified services for this fixed, predetermined payment for a specified length of time, regardless of how many times the member uses the services. The rate can be fixed for all members or adjusted for the age and sex of the member, based on actuarial projections of medical utilization.

Certified Diabetes Educator An individual credentialed by the National Certification Board of Diabetes Educators. The credential requires unrestricted license or registration (e.g., RN, RD), a master’s degree from a U.S. college or university in nutrition, and 2 calendar years of experience in direct diabetes patient and self-management education. Within 5 calendar years prior to the date of application, the individual must have worked a minimum of 1,000 hours in direct diabetes patient and self-management education. Must be engaged in practice of direct diabetes patient and self-management education at time of application.



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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Appendix B Glossary Ambulatory care In this report, ambulatory care refers to the outpatient care setting. Cachexia Loss of fat-free mass, especially body cell mass, with little or no weight loss. The metabolic hallmarks of cachexia are hypermetabolism and hypercatabolism, driven by inflammatory cytokine-mediated acute phase responses. Capitation A per-member monthly payment to a provider that covers contracted services to health management organization members and is paid in advance. A provider agrees to provide specified services for this fixed, predetermined payment for a specified length of time, regardless of how many times the member uses the services. The rate can be fixed for all members or adjusted for the age and sex of the member, based on actuarial projections of medical utilization. Certified Diabetes Educator An individual credentialed by the National Certification Board of Diabetes Educators. The credential requires unrestricted license or registration (e.g., RN, RD), a master’s degree from a U.S. college or university in nutrition, and 2 calendar years of experience in direct diabetes patient and self-management education. Within 5 calendar years prior to the date of application, the individual must have worked a minimum of 1,000 hours in direct diabetes patient and self-management education. Must be engaged in practice of direct diabetes patient and self-management education at time of application.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Certified Dietary Manager A professional who works together with registered dietitians to provide quality nutritional care for clients in a variety of noncommercial settings and performs a myriad of specialized tasks; many work as food service managers in a hospital, long-term care center, or other facility. Must pass a nationally recognized credentialing exam and fulfill the requirements needed to maintain certified status. Certified Nutrition Specialist An individual credentialed by the Certification Board for Nutrition Specialists. The credential requires an advanced degree in nutrition from a regionally accredited program. Requires at least 1,000 hours of supervised experience or 4,000 hours of unsupervised experience. Certified Nutrition Support Dietitian A professional who has been certified to deliver parenteral or enteral nutrition support. Certification by written examination is available through the National Board of Nutrition Support Education, Inc., to nurses, physicians, and dietitians. Commission on Accreditation of Dietetics Education The American Dietetic Association’s accrediting agency for education programs preparing students for careers as Registered Dietitians or Dietetic Technicians, Registered. Commission on Dietetic Registration Credentialing agency for the American Dietetic Association. The purpose of the commission is to protect the nutritional health and welfare of the public by establishing and enforcing certification and recertification standards for the dietetics profession. Credentials are issued to individuals who meet its standards to practice in the profession. Current procedural terminology A system of procedure codes and descriptions published annually by the American Medical Association. This procedure coding system is accepted by almost all commercial insurance carriers and is required by Medicare and Medicaid. Diagnosis-Related Group Program A program in which hospital procedures are rated in terms of cost, taking into consideration the intensity of the services delivered. A standard flat rate per procedure is derived from this scale, which is paid by Medicare for its beneficiaries, regardless of the cost to the hospital to perform the procedure. Dialysis Dialysis involves filtering the blood to remove toxins. Two primary forms of dialysis are available to outpatients: hemodialysis, which is usually administered three times a week for several hours, and continuous ambulatory peritoneal dialysis. Continuous ambulatory peritoneal dialysis is performed by the patient who administers and then drains a dextrose-containing fluid into and out of the peritoneal space.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Dietetic technician, registered Professionals who have (1) completed a minimum of an associate degree at a U.S. regionally accredited college or university; (2) completed a dietetic technician program approved by the CAADE of the ADA; (3) successfully completed the registration examination for dietetic technicians; and (4) accrued 50 hours of approved continuing professional education every 5 years. Often work with dietitians in a variety of employment settings, including health care, business and industry, public health, food service, and research. Disease management The process of standardizing treatment of common disorders and ensuring appropriate utilization and high-quality care at all levels by the provider. In disease management, the total management of the disease (e.g., practice guidelines and standards of care that direct clinicians) is evaluated, along with the cost of the process. Outcomes are evaluated by continuous quality improvement measures. By standardizing care, providers may reduce long-term care of patients with chronic illness. Doctor of Chiropractic A provider of spinal and other therapeutic manipulation or adjustments. Chiropractors also utilize a variety of manual, mechanical, and electrical therapeutic modalities, and provide patient evaluation and instructions regarding disease prevention and health promotion through proper nutrition, exercise, and life-style modifications. Doctor of Naturopathic Medicine A professional who is trained in basic medical science and conventional diagnostics, and qualified through licensing to scientifically apply natural therapeutics in the treatment of disease and restoration of health. Attends a 4-year, graduate-level naturopathic medical school and is educated in all of the same basic sciences as an M.D. but also studies holistic and nontoxic approaches to therapy with a strong emphasis on disease prevention and optimizing wellness. Elderly Nutrition Program Title III–VI feeding, congregate feeding, and home delivered meals for the elderly. End-stage renal disease Renal disease that is treated by dialysis. Enteral nutrition Nutrition provided through a feeding tube into the gastrointestinal tract. Failure to thrive A syndrome of weight loss, decreased appetite, poor nutrition, and inactivity often accompanied by dehydration, depressive symptoms, impaired immune function, and low cholesterol. Recently, some have advocated abandoning this term as a disease construct in favor of four treatable contributor domains: (1) impaired physical functioning, (2) malnutrition, (3) depression, and (4) cognitive impairment.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Fee for service Traditional reimbursement system in which providers are paid according to the service performed. This is the system used by conventional indemnity insurers. Fellow of the American Dietetic Association Registered dietitian with advanced education and experience who demonstrates exceptional professional abilities and expertise; can document professional achievement; is committed to self-growth, innovation, and service to others; and serves as an exemplary professional role model. Home health agency An agency providing care to individuals requiring skilled home care services. Home health agencies are often Medicare certified and meet minimum federal requirements for patient care and management. Some agencies deliver a variety of home care services through physicians, nurses, therapists, social workers, and others, whereas other agencies limit their services to nursing and one or two other specialties. Home health agencies can also coordinate a caregiving team to administer services that are comprehensive for individuals who require care from more than one specialist. Personnel are assigned according to the needs of each patient; since home health agencies recruit and supervise their personnel, they assume liability for all care. Home nutrition care provider Clinician with expertise in nutrition support who is responsible for medical aspects of a patient’s home nutrition care. Home nutrition therapy Nutrition therapy in the home environment. Interim payment system Presently being used in home care until a prospective payment system is developed. Intradialytic parenteral nutrition Infusion of an energy and/or amino acid mixture during dialysis treatment. Long-term care Services that are ordinarily provided in a skilled nursing care, intermediate care, personal care, supervisory care, or elder care facility. Long-term care facility Residential institution that provides extended care to individuals under the direct guidance of qualified health care providers. Malnutrition Any disorder of nutrition status including disorders resulting from a deficiency of nutrient intake, impaired nutrient metabolism, or overnutrition. Managed care A full range of health care structures and strategies

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population that focus on decreasing fragmentation of care and increasing quality and cost-efficiency. Micronutrient Nutrient present and required in the body in minute quantities (e.g., vitamins, trace elements). Nutrients Proteins, carbohydrates, lipids, vitamins, minerals, trace elements, and water. Nutrition screening The process of identifying characteristics known to be associated with nutrition problems. Its purpose is to identify individuals who are nutritionally at risk for malnutrition or who are malnourished. Nutrition services For the purposes of this report, nutrition services consist of two tiers. The first tier of services is basic nutrition education or advice, which is generally brief, informal, and typically not the focal reason for the health care encounter. More often than not, its aim is to promote general health and/or the primary prevention of chronic diseases or conditions. The second tier of nutrition services is the provision of nutrition therapy, which includes individualized assessment of nutritional status, evaluation of nutritional needs, and intervention, which ranges from counseling on diet prescriptions to the provision of enteral and parenteral nutrition. Nutrition therapy The treatment of a disease or condition through the modification of nutrient or whole-food intake. Nutrition therapy encompasses the assessment of an individual’s nutritional status, evaluation of nutritional needs, and interventions or counseling to achieve optimal clinical outcomes. The assessment of nutritional needs takes into consideration the individual’s medical and dietary histories, as well as physical, anthropometric, and laboratory data. Nutrition therapy includes oral, enteral, and parenteral nutrition interventions and takes into consideration the cultural, socioeconomic, and food preferences of the individual. Nutritional assessment A comprehensive evaluation to define nutrition status, including medical history, dietary history, physical examination, anthropometric measurements, and laboratory data. Nutritional support services or team Multidisciplinary group of health-care professionals with expertise in nutrition who aid in the provision of nutrition support. Obesity Body mass index (wt(kg)/ht(cm)2) greater than 30. Parenteral nutrition Delivery of nutrients intravenously rather than through the gastrointestinal tract.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Post-acute care Care in any setting beyond a short-stay, acute care hospital. Practice guidelines Systematically developed statement to assist practitioner and patient decisions about appropriate health care for specific circumstances. Statements suggesting the proper indications for a procedure or treatment or the proper management of specific clinical problems. Pre-end-stage renal disease Renal disease identified prior to dialysis or defined in terms of glomerular filtration rates of 13 to 50 ml/min/ 1.73 m2. Primary prevention Prevention of the development of disease in a person who does not have the disease through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after effects of existing disease. Programs of All-Inclusive Care for the Elderly Programs that integrate acute and long-term services in an attempt to improve coordination by bridging through common financing, acute care benefits, and home-and community-based long-term care services. Prospective payment system A payment system under which health care providers are paid a predetermined, fixed amount for patient care. Although prospective payment rates may be related to the costs providers incur in providing services, the amount a provider is paid for a service is unrelated to the provider’s actual cost of providing the specific service to a given individual. Protein–energy undernutrition The presence of clinical (physical signs such as wasting, low body mass index) and biochemical (albumin or other protein) evidence of insufficient intake. Registered Dietitian (RD) Food and nutrition expert who has met the following criteria to earn and maintain the RD credential: (1) completed a minimum of a bachelor’s degree; (2) met current minimum academic requirements as approved by the CAADE; (3) completed preprofessional experience accredited or approved by the CAADE; (4) successfully completed the registration examination for dietitians; and (5) accrued 75 hours of approved continuing professional education every 5 years. Sarcopenia Loss of muscle mass specifically, which appears to be an age-related condition. Secondary prevention Prevention of recurrence of a disease in a person who has already been diagnosed with the disease.

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The Role of Nutrition in Maintaining Health in the Nation’s Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population Skilled nursing facility An institution that primarily provides skilled nursing care and related services for residents who require medical or nursing care; rehabilitation services for the rehabilitation of injured, disabled, or sick persons; or, on a regular basis, health-related care and services to individuals who because of their mental of physical condition require care and services, above the level of room and board, which can be made available to them only through institutional facilities. Tertiary prevention Prevention of disability, poor quality of life, and death in persons with advanced stages of a disease. Wasting Unintentional loss of weight, including both fat and fat-free components. Experience in the human immunodeficiency virus epidemic suggests that wasting is driven largely by inadequate dietary intake.