Improving Care for the End of Life, Online Edition The Washington Home Center for Palliative Care Studies

Sourcebook : Improving Care for the End of Life : Glossary

acetaminophen - an antipyretic (reducing fever) and analgesic (reducing pain)

adjuvant therapy - treatment alongside the central treatment, usually aimed at reducing the risk of recurrence of cancer or at delaying onset of problems with widespread disease

advance directive - a set of instructions, usually written, intended to allow a patient's current preferences to shape medical decisions during a future period of incompetence

Alzheimer's disease - progressive mental deterioration manifested by loss of memory, ability to calculate, and visual-spatial orientation, along with confusion and disorientation

analgesic - a compound capable of relieving pain by altering perception of pain without producing anesthesia or loss of consciousness

antidepressants - agents used in treating/counteracting depression

Balanced Budget Act - a 1997 act of Congress that has major, and as yet uncertain, effects on the financing of care through Medicare

benzodiazepines - any of a group of tranquilizers that includes Valium

bereavement - an acute state of intense psychological sadness and suffering experienced after the tragic loss of a loved one

cancer - general term frequently used to indicate any of various types of malignant neoplasms, most of which invade surrounding tissues, may metastasize to several sites, and are likely to recur after attempted removal and to cause death of the patient. Some cancers can be effectively treated, especially if detected early. Most are eventually fatal.

capitation - a mode of paying for health services by a fixed rate per person per unit of time, usually a month

cardiopulmonary resuscitation (CPR) - restoration of cardiac output and pulmonary ventilation following cardiac arrest and apnea, using artificial respiration and manual closed-chest compression or open-chest cardiac massage

case manager - a person, usually a social worker or nurse, who helps to coordinate the services needed for a patient with complex chronic illness, usually while living at home

change concept - a general idea for how to accomplish improvement

chaplain - an individual ordained or consecrated for religious ministry, specially trained to offer support, prayer, and spiritual guidance to patients and families

chemotherapy - treatment of a disease by means of chemical substances or drugs; usually used in reference to cancer treatment

chlorpromazine - an antipsychotic and tranquilizing agent with antiemetic (preventing vomiting) and other effects

chronic disease - an illness marked by long duration or frequent recurrence

chronic obstructive pulmonary disease (COPD) - general term used for those diseases with permanent or temporary narrowing of small bronchi, in which forced expiratory flow is slowed, often called emphysema or bronchitis

chronic pain - pain that may exist for months or years, rarely causing changes in heart rate or blood pressure but often causing loss of appetite, sleep disturbance, and depression

codeine - an analgesic and cough suppressant; an opioid drug

congestive heart failure (CHF) - inadequacy of the heart as a pump so that it fails to maintain adequately the forceful circulation of blood, with the result that congestion and edema develop in the tissues

continuity - absence of interruption, a succession of parts intimately united

continuous quality improvement - an approach to quality improvement in which past trials of change are used as the basis of future trials and something is always being tested for its effects on improvement

curative - having healing or curing properties

defibrillator devices - any device whose purpose is to restore the natural rhythm of a fibrillating heart (a heart undergoing rapid irregular contractions)

dementia - the loss, usually progressive, of cognitive and intellectual functions, without impairment of perception or consciousness; caused by a variety of disorders, most commonly structural brain disease. Characterized by disorientation and impaired memory, judgment, and intellect. Often, Alzheimer's disease.

delirium - an altered state of consciousness, consisting of confusion, distractibility, disorientation, disordered thinking and memory, defective perception, prominent hyperactivity, agitation, and autonomic nervous system overactivity; caused by a number of toxic structural and metabolic disorders

demonstration project - organized implementation of a novel approach to providing care, with evaluation, and aimed at assessing the merits of widespread use of the approach

diagnosis - the determination of the nature of a disease

diagnosis related group (DRG) - the basis of payment for hospitalization in Medicare, in which a group of related conditions of similar average costs are paid this same fixed rate for almost all costs associated with a hospitalization (except physician's fees)

dietitian - an expert in the practical application of diet in the prevention and treatment of disease

"do not resuscitate" order (DNR) - an order dictating that an individual does not desire resuscitative measures in the case of failed breathing or cardiac arrest

doula - originally, a layperson who helps a new mother through pregnancy and early infant care, and now a model being tested to use experienced volunteers to help persons facing serious illness

dyspnea - shortness of breath, a subjective difficulty or distress in breathing, usually associated with disease of the heart or lungs

electrocardiogram (EKG, ECG) - graphic record of the heart's integrated action currents obtained with the electrocardiograph

emergency medical system - services specifically designed, staffed, and equipped for the emergency care of patients

end of life - the period of time marked by disability or disease that is progressively worse until death

equianalgesic conversions - the approximate dose of an opioid drug that is equal to one now being given. Essential for converting from one drug or route to another.

ethics committee or consultant - a service of many hospitals and a few other care provider programs, which provides expertise on ethics issues and conflicts of values

etiology - the cause of a disease

evaluation and management services - a category of billing for physician services that focuses on understanding the patient's problems and arranging a care plan to help

fatigue - that state, following a period of mental or bodily activity, characterized by a lessened capacity for work and reduced efficiency of accomplishment, usually accompanied by a feeling of weariness, sleepiness, or irritability

fee-for-service - payments to health care providers based on each service provided

fiscal intermediary - the company that receives bills for Medicare, evaluates their appropriateness, and issues payment on behalf of Medicare

full risk capitation - the capitation payment to an insurer or provider is to pay for all covered services including hospitalization, and the organization that accepts capitation is at risk for all costs

furosemide - a highly potent diuretic (drug to increase urination)

health maintenance organization (HMO) - provider and insurer that accepts full risk capitation and aims, among other things, to be more efficient by emphasizing prevention

hemodynamic - relating to the physical aspects of the blood circulation

home health aide - person who assists ill, elderly, or disabled persons in the home, carrying out personal care and housekeeping tasks

home health agency - an agency that offers home care services through physicians, nurses, therapists, social workers, and homemakers whom they recruit and supervise

hospice - a care program that provides a centralized program of palliative and supportive services to dying persons and their families, in the form of physical, psychological, social, and spiritual care; such services are provided by an interdisciplinary team of professionals and volunteers who are available at home and in specialized inpatient settings

hospital - an institution for the treatment, care, and cure of the sick and wounded, for the study of disease, and for the training of physicians, nurses, and allied health personnel

hydration - the taking in of water

hypersomnolence - excessive drowsiness

hypoxemia - subnormal oxygenation of arterial blood, short of anoxia (absence or almost complete absence of oxygen from inspired gases, arterial blood, or tissues)

IHI - the Institute for Healthcare Improvement; teaches quality improvement and coordinates the Breakthrough Series

immediate t-bar placement - a one-step ventilator cessation with continued airway support

innovation - a newly introduced practice or method intended to improve the current practice

inpatient respite care - admission of a patient to a hospital, nursing facility, or inpatient hospice to allow the family to have a period without direct caregiving. Also, a payment rate for this service in the Medicare hospice benefit.

inpatient symptom management care - admission of a patient to a hospital, nursing facility, or inpatient hospice to control symptoms. Also, a payment rate for this service in the Medicare hospice benefit.

intensive care unit (ICU) - a hospital facility for provision of intensive nursing and medical care of critically ill patients, characterized by high quality and quantity of continuous nursing and medical supervision and by use of sophisticated monitoring and resuscitative equipment

interim payment system (IPS) - a temporary and complex payment system under the Balanced Budget Act. Early effects have been particularly problematic for complex patients needing nursing facility care or home care.

intractable pain - pain that is not easily managed, governed, or alleviated

institutional review board (IRB) - a panel at each institution doing research on human subjects that reviews the risks posed to subjects and the consent process proposed

long-term care facility - a facility that provides a range of health, personal care, social, and housing services to people who are unable to care for themselves independently as a result of chronic illness or mental/physical disabilities

lorazepam - a benzodiazepine

management information system - a data system for managing a care program, usually at least providing information needed for billings and collections

Medicaid - a program of medical aid designed for those unable to afford regular medical service and financed by the state and federal governments in the United States

medical power of attorney - authority to act for another regarding medical decisions

Medicare - a U.S. government program of medical care especially for the aged and disabled

meperidine - meperidine hydrochloride; a widely used narcotic analgesic that should have very limited use because it is short-acting but has long-lived psychotigenic metabolites

minimum data set (MDS) - a set of data collected on a regular basis concerning all residents of long-term care facilities

modality - a form of application or employment of a therapeutic agent or regimen

morphine - the most commonly used opioid drug

narcotic antagonist - an agent inhibiting the effect of narcotics on the central nervous system

Nuremberg Code - agreement to protect patients involved in research. A cornerstone is the requirement for voluntary and informed consent.

nurse practitioner - a registered nurse with at least a master's degree in nursing and advanced education in the primary care of particular groups of clients, capable of independent practice in a variety of settings

nursing home - a facility for the care of individuals who do not require hospitalization and who cannot be cared for at home

oncologist - a specialist in the study of the physical, chemical, and biological properties and features of cancers, including causation, pathogenesis, and treatment

opioid - a drug possessing some properties characteristic of opiate narcotics but not derived from opium; the class of drug including narcotics such as morphine

opiophobia - unreasonable fear of the potential effects of opioids, affecting clinicians as well as the public

Programs for All-Inclusive Care of the Elderly (PACE) - a federal program offering elderly clients a range of health care services, transportation, food, and social activities, as well as physical, recreational, and occupational therapy

pain assessment tool - a device, like a "face scale" or questionnaire, used to assess a patient's pain

pain ruler - a pain assessment tool in which a patient marks severity of pain as a distance along a ruler

palliative care services - services designed to provide relief of symptoms that interfere with quality of life when treatments won't change the time course of the illness

Patient Self-Determination Act (PSDA) - a federal statute requiring patients to be informed of their authority to make certain medical decisions, under state law

per capita rate, AAPCC - the rate paid for each patient, each month, in Medicare. AAPCC stands for "area average per capita cost," which is based on the average past utilization in that area and is adjusted only for age and gender. This payment system is set to change with the Balanced Budget Act, both to have somewhat more uniform payments across the nation and to adjust somewhat for illness status (risk adjustment)

physician orders for life-sustaining treatment (POLST) - a physician order form that records patient preferences and treatment intentions; meant to enhance the appropriateness and quality of care and assist health care providers in honoring patients' treatment wishes

primary care - care of a patient by a member of the health care system who has had initial contact with the patient

prognostication - a forecast of the probable course and/or outcome of a disease

prospective payment system (PPS) - comprehensive payment for an episode of care, on the basis of initial problems (see also Diagnostic Related Group, the PPS for hospitals)

proxy - an individual who has been granted the authority or power to act on another's behalf

protocol - a precise and detailed plan for the study of a biomedical problem or for a regimen of therapy

psychosocial - involving both psychological and social aspects

psychostimulants - a medication with energizing or mood-elevating effects

quantitative measures - measures that can be expressed in terms of definite numbers or amounts

recreational/occupational therapy - a form of therapy that encourages and instructs manual activities for therapeutic or remedial purposes in mental and physical disorders

resource utilization groups-version III (RUG-III) - classification of patients in nursing facilities by disability and other care needs, for the purpose of determining coverage and rates in the Medicare system

routine home care - a daily rate in the Medicare hospice benefit; at least 80 percent of the Medicare beneficiary payment days must be at this rate

sedative-hypnotics - medications that cause sleep or sleepiness

skilled nursing facilities (SNF) - a residential facility that provides professional nursing around the clock, usually along with rehabilitation

status quo - the existing state of affairs

stroke - term denoting the sudden development of focal neurological deficits usually related to impaired cerebral blood flow

supportive services - care services designed to help patient and family cope with the effects of illness and disability, rather than to alter the course of disease

system leader - a chief executive officer, president, or other authoritative leader of a care system

tachycardia - rapid beating of the heart, conventionally applied to rates over 100 per minute

tachypnea - rapid breathing

terminal extubation - the rapid cessation of mechanical ventilation and removal of the artificial airway, often followed by administration of humidified air or oxygen

terminal weaning - a stepwise reduction of ventilatory support, leaving the artificial airway in place during the withdrawal of ventilation

therapeutic - relating to the treatment, remediation, or cure of a disorder or disease

thioridazine - an antipsychotic and tranquilizer, also useful for limiting nausea

treatment modalities - methods of treatment

tricyclics - tricyclic antidepressants; a group of related medications used to relieve depression and to enhance the effects of opioid analgesics, among other actions

ventilator - a machine that takes over breathing for the patient, controlling the intake and expiration of air

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.

For further information on quality improvement in end-of-life care visit The Washington Home Center for Palliative Care Studies [ www.medicaring.org ].

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