Glossary of Terms

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Accreditation Council for Continuing Medical Education (ACCME) works toward the identification, development, and promotion of standards for quality continuing medical education (CME) utilized by physicians in their maintenance of competence and incorporation of new knowledge to improve quality medical care for patients and their communities.

Active is collaboration in the design and/or implementation of a QI effort over an appropriate period of time.

Aim is a clearly articulated statement that provides both the foundation and the focus of a problem solving effort. An aim statement should be specific, measurable, achievable, realistic, and timely (SMART) and should answer the questions how good, by when, and for whom (or for what system).

Appropriate is how well a process, measure, data collection policy, collection frequency, etc. addresses its intended purpose. Determining appropriateness for QI efforts requires evaluation of how well the QI effort is aligned with the organization’s vision, mission, and goals.

Attestation is the process by which the physician declares in writing that he or she has participated in the stated activity. An attestation statement is a document provided by the Portfolio Program that the physician must complete in order to receive MOC Part IV credit for participating in an approved QI effort.


Balancing measure (or counter-balance measure) is a measure that is related to or affected by an improvement cycle. To achieve improvement in some measures while degrading performance in others usually is not acceptable. In making changes to improve outcome or process measures, balancing measures are those related measures that should be maintained or improved.



Data are documented observations, including those that result from a measurement process. When dealing with continuous measurements or counts of observations, patterns are often easier to recognize when the data are plotted over time. Plotting data over time maximizes the learning from data.




Health Insurance Portability and Accountability Act (HIPAA) sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.


Institute of Medicine (IOM) is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and to the public. The IOM has outlined six Aims for Improvement for health care; safety, effectiveness, timeliness, equity, efficiency, and patient-centeredness.





Maintenance of Certification (MOC) assures that physicians certified by one the 24 ABMS Member Boards are committed to lifelong learning and competency in a specialty and/or subspecialty. MOC requires ongoing measurement of six core competencies; patient care, medical knowledge, interpersonal communication skills, professionalism, systems-based practice, and practice-based learning and improvement.

Meaningful participation is demonstration of having an active (see active) role in a QI effort over a period of time in which the physician implements the intervention(s) related to the QI effort, and collects (if data collection is not automated), submits, and reviews appropriate measurement data.




Patient is the person receiving health care, including preventive, promotional, acute, chronic, rehabilitative, and all other services in the continuum of care.

Physician practice is the scope of practice in which the physician is involved that provides direct patient care services, or serves to improve the health of a population (including occupational health, quality officers, military physicians, etc.)

Portfolio Sponsor is a sponsor organization (see sponsor organization) that is approved through this program to develop and oversee QI efforts and approve those efforts as eligible for MOC Part IV credit.


Quality improvement (QI) is a formal approach to the analysis of performance in human systems and to systematic efforts to improve performance involving both prospective and retrospective reviews. Methodologies include FADE, PDSA/PDCA, Six Sigma (DMAIC), Continuous Quality Improvement (CQI), Total Quality Management (TQM), and LEAN. Each is a means to get to improvement and share the common principles of understanding systems, understanding variation in processes over time, understanding theories of knowledge, and understanding the psychology of change in complex organizations. QI methodologies avoid attributing blame while creating systems to prevent errors from happening.


Reflection (or learning) is the process of critically thinking about the activity, the results of the activity, and the impact of the activity on the physician, the physician’s practice, and the affected patient population.

Relevant is directly connected and/or pertinent to the physician’s clinical practice.


Sponsor organization is any entity, regardless of size, with primary ownership of the design and execution of QI efforts. Sponsor organizations may include academic medical centers, accountable care organizations, cooperatives or collaboratives, foundations, health systems, hospitals (for-profit or not-for-profit), independent practice associations, insurance providers or payers, physician hospital organizations, quality improvement organizations, societies, or associations.