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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary APPENDIX B Glossary and Acronyms Acronyms AAFP American Academy of Family Physicians (www.aafp.org) AAHP American Association of Health Plans (www.aahp.org) AAMC Association of American Medical Colleges (www.aamc.org) AAP American Academy of Pediatrics (www.aap.org) ACOG American College of Obstetricians and Gynecologists (www.acog.com). AHCPR Agency for Health Care Policy and Research (www.ahcpr.gov) ASM American Society for Microbiology (www.asmusa.org) CALINX California Information Exchange (www.calinx.org). CDC Centers for Disease Control and Prevention (www.cdc.gov). DHHS U.S. Department of Health and Human Services (www.os.dhhs.gov). FDA U.S. Food and Drug Administration (www.fda.gov). HCFA Health Care Financing Administration (www.hcfa.gov). NCI National Cancer Institute, National Institutes of Health (www.nci.nih.gov). NCID National Center for Infectious Diseases, Centers for Disease Control and Prevention (www.cdc.gov/ncidod/ncid.htm). NIAID National Institute of Allergy and Infectious Diseases, National Institutes of Health (www.niaid.nih.gov).
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary NIHNational Institutes of Health (www.nih.gov). PBGHPacific Business Group on Health (www.pbgh.org). Glossary This glossary is intended to define terms commonly encountered throughout this workshop summary as well as some terms that are commonly used in the managed care industry. This glossary is not all-inclusive. New terms and new usages of existing terms will emerge with time and advances in technology. Definitions for the terms presented here were compiled from a multitude of sources, which are listed at the end of the glossary. Academic Health Centers (AHCs): Academic health centers, or AHCs, consist of health care institutions that are owned by or closely affiliated with a university or medical school. AHCs also have at least one additional health professional program, and are engaged in undergraduate and graduate medical education, biomedical research, and delivery of patient care. Antibiotic: Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin from molds), but many currently used antibiotics are semisynthetic and are modified by the addition of artificial chemical components. Antibiotic resistance: Property of bacteria that confers the capacity to inactirate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics. Antimicrobial agents: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi. Bacteria: Microscopic, single-celled organisms that have some biochemical and structural features different from those of animal and plant cells. Basic research: Fundamental, theoretical, or experimental investigation to advance scientific knowledge, with immediate practical application not being a direct objective. Benchmark: For a particular indicator or performance goal, the industry measure of best performance. The benchmarking process identifies the best performance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance. Broad-spectrum antibiotic: An antibiotic effective against a large number of bacterial species. It generally describes antibiotics effective against both gram-positive and gram-negative classes of bacteria.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary CAMAS (Completeness and Accuracy of Managed-Care Administrative Data Sets): A single study involving the accuracy and completeness of administrative data sets, funded by a grant from the California HealthCare Foundation to CALINX (California Information Exchange). Capitation: A per member, per month payment to a health care provider or health plan for each member enrolled, regardless of the amount of care that a member requires. CHAMPUS (Civilian Health and Medical Program of the Uniformed Services): A cost-sharing program that helps eligible military families and retirees and retiree families pay for civilian care when military care is not available. CHAMPUS is now called TRICARE Standard in most of the country. Clinical practice guidelines: Systematically developed statements that assist practitioners and patients with decision making about appropriate health care for specific clinical circumstances. Clinical research: Investigations aimed at translating basic, fundamental science into medical practice. Clinical trials: As used in this workshop summary, research with human volunteers to establish the safety and efficacy of a drug, such as an antibiotic or a vaccine. Clinicians: One qualified or engaged in the clinical practice of medicine, psychiatry, or psychology, as distinguished from one specializing in laboratory or research techniques in the same fields. Disease: The condition in which the functioning of the body or a part of the body is interfered with or damaged. In a person with an infectious disease, the infectious agent that has entered the body causes it to function abnormally in some way or ways. The type of abnormal functioning that occurs is the disease. Usually the body will show some signs and symptoms of the problems that it is having with functioning. Disease should not be confused with infection. Efficacy: As used in this workshop summary, the probability of benefit to individuals in a defined population from a medical technology applied for a given medical problem under defined conditions of use. Emerging infections: Any infectious disease that has come to medical attention within the last two decades or threatens to increase in the near future (IOM, 1992). Many times, such diseases exist in nature as zoonoses and emerge as human pathogens only when humans come in contact with a formerly isolated animal population, such as monkeys in a rain forest that are no longer isolated because of deforestation. Drug-resistant organisms could also be included as emerging infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human immunodeficiency virus, Ebola virus, and multi-drugresistant Mycobacterium tuberculosis.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary Endemic: Disease that is present in a community or common among a group of people; said of a disease continually prevailing in a region. Etiology: Science and study of the causes of diseases and their mode of operation. FDA Modernization Act of 1997: An act to amend the Federal Food, Drug, and Cosmetic Act and the Public Health Service Act to improve the regulation of food, drugs, medical devices, and biological products. Federal Food, Drug, and Cosmetic Acts of 1938 and 1962: Laws that require a manufacturer to prove the safety and effectiveness of a drug before it can be marketed. Fee-for-service system: The traditional health care payment system under which physicians and other providers receive a payment for each unit of service that they provide. Formulary: List of drugs approved for the treatment of various medical indications. It was originally created as a cost-control measure, but it has been used more recently to guide the use of antibiotics on the basis of information about resistance patterns. Group model HMO (health maintenance organization): A type of HMO whereby an organized group of practitioners contracts with an HMO to provide services, often on a mutually exclusive basis. The provider organization receives a negotiated, per capita payment which may be distributed to individual clinicians by salary, capitation payments, fee-for-service reimbursements, or incentive payments. HEDIS (Health Plan Employer Data and Information Set): A set of standardized performance measures for health plans related to member satisfaction, quality and access, physician network, utilization, membership, and finance. HIPAA (Health Insurance Portability and Accountability Act of 1996): An act designed to protect health insurance coverage for workers and their families when workers change or lose their jobs. HMO (health maintenance organization): An organized system of health care that arranges a comprehensive range of health care services to a voluntarily enrolled population in a geographic area on a primarily prepaid and fixed periodic basis. This health care service plan requires its subscriber members, except in a medical emergency, to use the services of designated physicians, hospitals, or other providers of medical care. HMOs typically use a capitation payment system that rewards providers for cost-effective management of patients. Immunogenicity: The property that endows a substance with the capacity to provoke an immune response or the degree to which a substance possesses this property.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary Incidence: The frequency of new occurrences of disease within a defined time interval. Incidence rate is the number of new cases of a specified disease divided by the number of people in a population over a specified period of time, usually 1 year. Individual Practice Association (IPA) model: A model in which an HMO contracts with Independent Practice Associations (IPAs) to provide care. The IPAs are generally directed and often owned by member providers who retain their independent practices but use the IPAs to obtain managed care contracts and, on occasion, to administer care-related services. Infection: The entry and development of an infectious agent in the body of a person or animal. In an apparent, "manifest" infection, the infected person outwardly appears to be sick. In an unapparent infection, there is no outward sign that an infectious agent has entered that person at all. Infection should not be confused with disease. Invasive isolates: A pure culture of a microorganism that is capable of (1) penetrating the host's defenses, (2) entering host cells, or (3) passing through mucosal surfaces and spreading in the body. MCO (managed care organization): An organization that arranges for health care delivery and financing and that is designed to provide appropriate, effective, and efficient health care through organized relationships with providers. Includes formal programs for ongoing quality assurance and utilization review, financial incentives for covered members to use the plan's providers, and financial incentives for providers to contain costs. Managed care plans vary greatly in the degree to which benefit coverage is offered, monitored, and conditioned upon certain criteria being met by the subscriber member and the member's primary care physician. Medicaid: A federal government program that helps pay for health care for indigent and disabled persons. The federal government reimburses a percentage of each state's expenditures; the states determine eligibility. Medicare: A federal government health care insurance program for people age 65 and over and for disabled people. Medicare helps pay for hospitalization charges, stays in skilled nursing facilities, physician charges, and some associated health care costs. Methicillin-resistant Staphylococcus aureus (MRSA): Strictly speaking, a Staphylococcus aureus strain resistant to the antibiotic methicillin. In practice, MRSA strains are generally resistant to many antibiotics and some are resistant to all antibiotics except vancomycin, such that the acronym is now generally used to mean "multi-drug-resistant S. aureus." MIC (minimum inhibitory concentration): The lowest antibiotic concentration that prevents bacterial growth. Mixed model HMO (health maintenance organization): A combination of two or more types of managed care organizations.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary MSO (management services organization): An organization that provides management, administration, and support services to individual physicians or group practices. Neonate: A newborn infant. Network model HMO (health maintenance organization): A type of HMO which contracts with individual clinicians, groups or IPAs, and hospitals to provide care. The contracts are usually not exclusive, and providers may be paid by capitation, fee-for-service, or other mechanisms. Clinicians may contract with the HMO directly or through an intermediary organization such as a medical group or IPA. Nosocomial infection: An infection that is acquired during hospitalization but that was neither present nor incubating at the time of hospital admission, unless it is related to a prior hospitalization, and that may become clinically manifest after discharge from the hospital. Outpatient services: Medical and other health care services not requiring hospitalization. These services may be provided by a hospital or other qualified facility or supplier, such as mental health clinics, rural health clinics, mobile X-ray units, or freestanding dialysis units. Such services include outpatient physical therapy services, diagnostic X-ray and laboratory tests, and radiation therapy. PHO (physician hospital organization): A legal entity formed or owned by hospitals and physicians to obtain payer contracts. Physicians may retain ownership of their practices but agree to accept managed care patients under terms negotiated by the PHO. POS (point-of-service) plan: An organized system of health care that is provided by a health maintenance organization and that provides the option of delivering services outside of the network for a higher copayment or deductible. PPO (preferred provider organization): A network, discount, fee-for-service provider arrangement with incentives to stay inside the network. This arrangement allows services outside of the PPO network but with an increased copayment or deductible, or both. A PPO has some structured quality and utilization management. Prenatal: Existing or occurring before birth. Primary care: Basic or general health care, traditionally provided by family practice, pediatric, and internal medicine physicians. Primary care physician: A general practitioner, board-certified or boardeligible family practitioner, internist, obstetrician/gynecologist, or pediatrician who has contracted with a managed care organization (MCO) to provide primary care to subscriber members and who refers, authorizes, supervises, and coordinates the provision of all health care of subscriber members in accordance with the MCO contract.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary Program Announcement (PA): A public announcement describing the goals and scope of a proposed scientific project awaiting approval from a specific scientific organization. Prophylactic antibiotics: Antibiotics that are administered before evidence of infection with the intention of warding off disease. Public Health Service Act of 1944: An act to consolidate and revise the laws relating to the U.S. Public Health Service. Requests for Applications (RFA): A public announcement from a scientific organization requesting applications from qualified people to perform a specific research assignment. Sepsis: The presence of pathogenic microorganisms or their toxins in blood or other tissues. Staff model HMO (health maintenance organization): An HMO in which practitioners are salaried employees of the HMO. The practitioners may also receive a bonus or other incentive income based on the performance of the HMO. Surveillance systems: Used in this workshop summary to refer to data collection and record-keeping to track the emergence and spread of disease-causing organisms such as antibiotic-resistant bacteria. Tertiary care: The aspect of inpatient care dealing with illnesses or conditions requiring specialized techniques, such as coronary artery bypass surgery, renal hemodialysis, and treatment of severe burns. Vaccine: A preparation of living, attenuated, or killed bacteria or viruses, fractions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organisms that is administered to raise immunity to a particular microorganism. Zoonotic disease or infection: An infection or infectious disease that may be transmitted from vertebrate animals (such as rodents) to humans. Definitions for this glossary were compiled from the following sources: Academic Health Centers in the Managed Care Environment. 1995. Korn D., C.J. McLaughlin, M. Osterweis, Eds. Washington, D.C.: Association of Academic Health Centers. Agency for Health Care Policy and Research (date of last update: November 4, 1998). Available at http://www.ahcpr.gov/. American Academy of Family Physicians (date of last update: July 23, 1998). Available at http://www.aafp.org/. American Academy of Pediatrics (date of last update: March 26, 1999). Available at http://www.aap.org/.
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Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention, Workshop Summary American Association of Health Plans (date of last update: July 19, 1998). Available at http://www.aahp.org/. American Medical Association. Manual of Style, 9th ed. Chicago: American Medical Association, 1998. Association of American Medical Colleges (date of last update: December 4, 1998). Available at http://www.aamc.org/. California Information Exchange (date of last update: January 21, 1999). Available at http://www.calinx.org/. Centers for Disease Control and Prevention (date of last update: March 25, 1999). Available at http://www.cdc.gov/. Dorland's Illustrated Medical Dictionary, 28th ed. Philadelphia: W.B. Saunders Co., 1994. Health Care Financing Administration (date of last update: March 25, 1999). Available at http://www.hcfa.gov/. Institute of Medicine. Orphans and Incentives: Developing Technologies to Address Emerging Infections. Workshop Report. P. F. Harrison and J. Lederberg, eds. Washington, D.C.: National Academy Press, 1997. Institute of Medicine. Antimicrobial Resistance: Issues and Options. Workshop Report. P.F. Harrison and J. Lederberg, eds. Washington, DC: National Academy Press, 1998. The Managed Care Yearbook, 4th ed. Manasquan, N.J.: The Managed Care Information Center, 1998. McGraw-Hill Dictionary of Scientific and Technical Terms, 5th ed. Washington, D.C.: McGraw-Hill, Inc., 1994. Medline plus (date of last update: March 18, 1999). Available at http://www.nlm.nih.gov/. Military Health System Web Site (date of last update: October 12, 1999). Available at http://www.tricare.osd.mil/. National Cancer Institute (date of last update: March 25, 1999). Available at http://www.nci.nih.gov/. National Center for Infectious Diseases (date of last update: March 23, 1999). Available at http://www.cdc.gov/ncidod/ncid.htm/. National Institute of Allergy and Infectious Diseases (date of last update: March 10, 1999). Available at http://www.nisid.nih.gov/. National Institutes of Health (date of last update: March 10, 1999). Available at http://www.nih.gov/. OneLook Dictionaries (date of last update: March 6, 1999). Available at http://www.onelook.com/. Pacific Business Group on Health (date of last update: January 21, 1999). Available at http://www.pbgh.org/. The American College of Obstetricians and Gynecologists: Women's Health Care Physicians (date of last update: March 1999). Available at http://www.acog.com/. U.S. Department of Health and Human Services (date of last update: February 26, 1999). Available at http://www.os.dhhs.gov/. U.S. Food and Drug Administration (date of last update: January 11, 1999). Available at http://www.fda.gov/. Webster's Third New International Dictionary. Springfield, Mass.: Merriam-Webster, Inc., 1986.
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