CALES (Syn: measurement scales) Ordering principle of characteristics or data. See BINOMINAL, NOMINAL, ORDINAL, INTERVAL, RATIO and COMPOSITE SCALE.
CAPITATION A form of payment based on the number of registered patients, to cover the partial or the full range of medical services provided.
CASE A person in the population, practice or study group identified as having the particular health problem under investigation or risk factor. May also be used to describe any such person receiving an intervention.
CASE BASED: In some audits, the care of individual cases is examined and general lession learnt.
CASE BASED DISCUSSION (CbD) – a structured interview designed to explore professional judgement exercised in clinical cases that have been selected and presented by the trainee. Usually this will be used 20 times in a 3 year program. (12 in ST3 in 2007-08)
CASE CONTROL STUDY A study that identifies persons with a problem and a control group without it. The relationship of an attribute to the problem is examined by comparing those with the problem and those without it. A CASE CONTROL STUDY is often referred to as a RETROSPECTIVE STUDY (even if patients are recruited prospectively) because the logic of the design leads from an effect in the present, i.e. the selection criterion for being a case, to a presumed cause in the past. The presumed causal chain is analysed retrospectively.
CASE SERIES A study of patients identified as having a specified health problem without comparison with a healthy control group, though historical controls can be used to make inferences. The description of a CASE SERIES is used to illustrate a point of view or to describe rare or unknown health problems. If the case series is compared with a control group systematically it is called a CASE CONTROL SERIES.
CASE STUDY A study of patients identified as having a specified health problem.
CASE-BASE STUDY A study that starts with the identification and sampling of persons with the problem of interest, and then samples the entire base population (of cases and non-cases) from which the original cases arose.
CASE-MIX The description of a patient population which defines the medical severity of that population, usually in terms of one or more of the following: a diagnostic profile, severity of illness, functional status, pathophysiologic measures, and socio demographic characteristics.
CATCHMENT AREA A region from which the cases of a particular study are drawn or for which services are provided.
CAUSALITY OF DISEASE, FACTORS IN A number of not mutually exclusive factors have been differentiated: l. Predisposing factors are those that prepare, sensitize or otherwise condition a patient to react in a specific way. Predisposing factors may be age, gender, marital status, knowledge, health beliefs, social status, etc. 2. Enabling factors facilitate the manifestation of the health problem or use of health services or even maintenance of health or appropriate use of health services. Enabling factors may be income, health insurance coverage, nutrition, social and health care system. 3. Precipitating factors are associated with the onset of a health problem, behaviour or course of action. If more than one factor is involved usually one is more important or obvious, and may be regarded as necessary. 4. Reinforcing factors tend to aggravate the presence of a health problem, attitude or behaviour. These factors may be repeated exposure to an infectious agent, work, stress or presence of financial incentive or disincentive.
CAUSALITY The relating of causes to the effects they produce. Epidemiologic evidence alone is not sufficient to prove causality. Inference from epidemiological evidence by the professional community, the reader of a publication, or even the investigator who published the evidence, can lead to acceptance of a causal relationship. This acceptance of causal relationship requires judgement, causality is not proven, but judged to be existent on basis of evidence. See also INFERENCE.
CbD Case-based discussion- a formative assessment tool
CCT Certificate of completion of training of medical speciality
CENSUS: An enumeration of a population, conducted every ten years in England and Wales.
CENTILE: As in for example ‘90th centile’: reference charts for height and weight in children show the normal range in percentages – a child above the 90th centile would be in the heaviest 10% of children of the same height
CERTIFICATE IN TRAINING PRACTICE. Awarded by the Institute of Personnel & development. Course organisers and other educationalists are being encouraged to attain this award
CHARTER MARK. A Government sponsored award (for 3 years) that involves setting and achieving standards for service in particular customer satisfaction
CHILD A person less than 15 years of age (0-14 years). Different health care systems may set different upper age limits for children's services.
CHILD DEATH RATE The number of deaths among children in the age group I-4 in a given year per 1000 children in this age group.
CHILDREN’S TRUST: A new organisation bringing together education, health and social care
CHIMP see Commission for Health Improvement (CHI)
CHI-SQUARE (X2) TEST A statistical test for detecting whether two or more population distributions differ from one another. This test usually involves counts of data, and may involve comparison of samples from the distribution under study, or the comparison of a sample to a theoretically expected distribution.
CHRONIC (Syn: long-term) A health problem or an episode of care lasting 6 months or longer. See EPISODE.
CLASS A term used in the theory of frequency distributions. Study observations may be grouped into classes to make subsequent analysis less laborious or for other reasons.
CLASS, SOCIAL A method of stratifying a population according to social characteristics like income, education, or occupation. See also SOCIOECONOMIC CLASSIFICATION.
CLASSIFICATION An arrangement of all elements of a domain into groups according to established criteria. A classification is characterized by: 1. Naturalness: the classes correspond to the nature of the things being classified. 2. Exhaustiveness: every relevant problem will fit into one and only one class in the system. 3. Constructability: the set of classes is constructed by a demonstrably systematic procedure.
CLASSIFICATION OF DISEASES Arrangement of diseases which have common characteristics into groups. The usefulness depends on the user and examples are: International Classification of Primary Care (ICPC), and the International Classification of Diseases, Injuries and Causes of Death (ICD).
CLASSIFICATIONS, FAMILY OF A group of compatible classifications which describes different aspects of health problems such as diagnosis, injuries, external causes, signs and symptoms, operative procedures, and diagnostic tests. There may be a conversion structure between different classifications.
CLINIC OR SPECIAL SESSION Occasions when patients of a similar type, or those suffering from the same health problem, are grouped together for supervision, examination, treatment, discussion, or advice. Appointments may or may not be required. The type of clinic should be specified, e.g. obstetric clinic for antenatal and postnatal care; child health clinic for care of children and babies; special clinics for obesity, geriatrics, diabetes, and other conditions.
CLINICAL ALGORITHM See ALGORITHM, CLINICAL.
CLINICAL AUDIT: audit of any aspect of clinical care provided by members of the practice team
CLINICAL EPIDEMIOLOGY The methodology and practice of research in occurrence, diagnosis, prognosis, therapy or determinants of health problems of patients in health care settings. CLINICAL EPIDEMIOLOGY is broader than CLINICAL RESEARCH as it includes methodology, i.e. the developing methods, techniques and theories of research. CLINICAL EPIDEMIOLOGY has emerged from the combination of clinical research and `classic' epidemiology of populations outside clinical settings, groups with (potential) health problems, in the domain of public health. A clinical epidemiologist can be a clinician or an other professional. CLINICAL EPIDEMIOLOGY includes decision analysis, technology assessment, meta-analysis, evaluation of health care systems, and other disciplines and techniques. Biostatistics is considered as a separate discipline (See Last, 1988).
CLINICAL GOVERNANCE: A framework through which healthcare organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. Improvement of patient care is through commitment to high standards, reflective practice, risk management and personal and team development. It means Quality Assurance in clinical care.
CLINICAL INERTIA: Failure of clinicians to initiate or intensify therapy when indicated
CLINICAL OUTCOME Specifies clinical status as a consequence of the course over time of a health problem, treatment, experiment, or other medical interventions. See CLINICAL STATUS, HEALTH OUTCOME.
CLINICAL PLACEMENT in relation to professional performance refers to a placement provided for a practitioner in a Trust or general medical or dental practice setting. This is normally a supernumerary position, with the purpose of providing a period of supervised practice for training and/or assessment.
CLINICAL PRACTICE EVALUATION PROGRAMME (CPEP) will offer a personal benchmarking system based on national data but adapted for local use
CLINICAL PROTOCOL A set of accepted procedures in a clinical situation.
CLINICAL RE-ENTRY in relation to professional performance refers to the part of a return to work programme that addresses the clinical concerns to allow a practitioner to return to safe professional practice.
CLINICAL RESEARCH Performing scientific investigations on occurrence, diagnosis, prognosis, therapy or determinants of health problems of patients in health care settings aimed at application of the derived knowledge to patient care.
CLINICAL STATUS (Syn: clinical health status) Health status of patients assessed in clinical settings by health care providers using medical procedures and judgement. The CLINICAL STATUS can be described in terms of reason for encounter (REF), symptoms, signs, diagnosis, results of additional diagnostic procedures, severity of the health problem, co-morbidity, and functional status. See also CLINICAL OUTCOME, FUNCTIONAL STATUS, HEALTH STATUS and SEVERITY OF ILLNESS.
CLINICAL SUPERVISOR in relation to professional performance refers to the individual who may be required to provide close supervision of a practitioner during a clinical placement, and to monitor and report on progress to the programme supervisor. This individual may be a senior consultant or a general medical or dental practitioner. Normally these individuals will be expected to have considerable experience in training/supervising practitioners in difficulty and to have received further training to equip them in this role.
Clinical Supervisor - The Clinical educator responsible for teaching and supervising the GPR in training in the individual attachment This may be a hospital clinical supervisor when the GPR is in a hospital attachment and a GP trainer when in General Practice.
CLINICAL TRIAL: research which involves a test regimen followed by patients intended to evaluate its efficacy and safety. The term is subject to a wide variation in usage. Trials of various interventions including drugs, surgery, radiotherapy, behavioural change, screening. Trials can be Phase 1,2 or 3.
CLOSE-ENDED QUESTIONS A -question that contains specific response options which can be answered with `yes' or `no'.
CLUSTERING A more irregular occurrence of events (encounters, episodes) than could be expected on the basis of a random distribution. CLUSTERS of relatively more frequent events alternate with periods of relatively less frequent events.
CME see Continuing Medical Education (CME)
COACH refers to an individual who assists in addressing primarily behavioural issues that have emerged from the assessment of the practitioner’s performance. The coach would help the practitioner reflect on such issues, develop self-awareness, set goals for change and practise improvements against these goals. A coach may come from a psychology background.
COCHRANE COLLABORATION has started the development of a social and educational Controlled Trials Register, which as it grows will be a major resource for those seeking evidence regarding the efficacy of educational programmes.
CODE A code is a fixed sequence of signs or symbols, alphabetic or numeric characters, serving to designate an object or a concept. In many coding systems such as ICPC, codes describe the position in the hierarchy of the concept. In others the codes are compound expressions. In most systems codes refer to concepts, but in some they refer to a particular term or terms used for a concept, e.g. separate codes may be provided for the preferred term and various synonyms for a single concept.
CODING STRUCTURE is a representational structure for coding systems.
CODING SYSTEM is a system for classifying objects and entities (such as health problems, procedures or symptoms) using a finite set of numeric or alphanumeric identifiers (codes).
COHORT STUDY A research method in which a defined group of persons with a common characteristic or set of characteristics (e.g. experiences, health problems) is followed for a specified period to determine the incidence of a health problem or complications of an established disease-that is, prognosis.
COHORT: Most audits refer to groups of patients with a distinguishing feature eg the elderly, hypertensives. The group concerned is a cohort
COMMUNITY A group of individuals organized into a unit, or manifesting some unifying trait or common interest; loosely, the locality or catchment area population for which a service is provided.
COMMUNITY CARE The care and supervision of persons outside secondary and tertiary hospitals by medical and social agencies providing primary care. Community-Oriented Primary Care is a special form which focuses concern so that medical services are congruent with community needs.
COMMUNITY DIAGNOSIS The process of appraising the health status of a community, assembling vital statistics, health statistics and other information pertaining to determinants of health. Community diagnosis may be comprehensive or restricted to specific health problems.
COMMUNITY MEDICINE (Syn: community health) That speciality of medicine devoted to meeting the health care needs of particular populations rather than individuals and therefore includes epidemiology, mass screening, environmental health, etc. See also PUBLIC HEALTH, SOCIAL MEDICINE.
COMMUNITY PARTICIPATION Responding to community needs ie working with community representatives in defining health issues and priorities.
COMMUNITY PHYSICIAN A medical practitioner whose primary concern is the health status of the population within a defined geographical area. He/she is usually responsible for assessment and evaluation of the community's health needs and for the organization of health services to meet those needs. He/she will generally not render personal health care, except for specific health problems such as selected communicable diseases. The role of a community physician varies from country to country, but he/she is usually employed by a government agency.
COMMUNITY WORKING with people to identify their concerns, and support and development facilitate them in collective action for the good of the community as a whole. Community Strategy published in April 2003 by the Bristol Partnership that sets strategy out the vision, aims and priorities for improving economic, social and environmental wellbeing and health in Bristol.
COMORBIDITY Health problems that co-exist in a patient in addition to the condition or problem which is being studied.
COMPARABILITY The quality or state of being equivalent or similar. One classification may be a subset of a larger system and would be equivalent at some level.
COMPATIBILITY In the area of classifications, the ability to interrelate in an established and consistent manner.
COMPETENCE The sum of personal attributes required to carry out a defined activity or fulfil a defined role.
COMPLAINT A symptom, disorder or concern expressed by the patient when seeking care. See also PROBLEM.
COMPLETION RATE The percentage of persons in a survey for whom a complete data set is available. See also RESPONSE RATE.
COMPLEX ADAPTIVE SYSTEMS THEORYS. Health care is populated by highly adaptable elements (healthcare professionals); inputs have non-linear effects (small changes that create large effects); there is a continuous production of new, "emergent behaviours"; like the weather, the future state of the system is intrinsically not predictable in detail; and, finally, simple rules can yield complex outcomes. These simple rules may also be used to describe those outcomes in a way that makes sense of them.
COMPLIANCE Proportion of a target population who accepts and completes all stages of a programme or the degree to which a patient follows the recommendations of the doctor
COMPLIANT INFRASTRUCTURE An IM&T environment that is needed to be of a particular specification to enable IM&T systems to work together.
COMPONENT Part of a larger concept or construct. For example, depression is a component of psychiatric illness.
COMPOSITE SCALE (Syn: index) Ordering characteristics or data by one value, a number or a count, derived from different scales that are by themselves ordered in a nominal way. For example: Apgar score, Dow-Jones-Index, Sickness Impact Profile. See HEALTH OUTCOME MEASURES.
COMPREHENSION: the ability to understand concepts
COMPREHENSIVE CARE Health care of all embracing scope. Since the family physician is available for any type of health problem, the care he provides is comprehensive.
COMPUTER ASSISTED DIAGNOSIS The application of computer technology to the diagnostic process.
COMPUTER ASSISTED INSTRUCTION The application of computer technology to learning.
COMPUTER ASSISTED LEARNING. Using computers to present information, set problems, run quizzes and obtain feedback
COMPUTER ASSISTED THERAPY The application of computer technology to therapy.
COMPUTER-BASED PATIENT RECORD (Syn: computer-based medical record) An electronic patient record that is specifically designed to support users by providing accessibility to complete and accurate data alerts, reminders, and other aids.
CONCEPT MAP. Diagram showing links between subtopics
CONCORDANCE is an agreement reached after negotiation between a patient and a health care professional that respects the wishes and beliefs of the patient in determining whether when and how medication is taken. Concordance assures the patient a proactive role in treatment decisions and a central theme in the partnership with the prescriber and pharmacist is an understanding of the patients beliefs and expectations for the treatment
CONDITION The current state of a patient's health. May also be used to mean a health problem. It is used if one tries to be more general than using the more specific term DISEASE. See DISORDER, DISEASE.
CONFERENCES – larger scale event involving 100+ delegates with an agenda of mixed presenters and sessions eg plenary and workshop
CONFIDENCE INTERVAL (Syn: C.I.) the CI quantifies the uncertainty in measurement; usually reported as 95% CI, which is the range of values within which we can be 95% sure that the true value for the whole population lies. A range of values for a variable, e.g. a rate, so that this range has a specified probability (most often 95%) of including the true value of the variable. Example: Relative Risk (95% C.I.) = 2 (1.3-2.6).
CONFIDENTIALITY (Syn: privacy, anonymity) Information is available to: 1. the patient only, and/or 2. individuals and authorities permitted by him/her, or 3. the patient is not personally identifiableanonymity.
CONFOUNDER (Syn: confounding variable) An unrelated, extraneous factor, unequally distributed among the subjects/groups in the study, which distorts the true relationship of th;, variables in the study.
CONSISTENCY A property of measurements that when repeated are in close agreement or conformity.
CONSULTANT A medical principal who is specially competent in a particular field of medicine and who provides services related to that field at the request of another health care provider. Formerly a consultant was one who was asked for. an opinion, which was not binding and which did not imply transfer of responsibility.
CONSULTATION A consultation is a meeting where the doctor, in a professional way, responds to a patient's fears, ideas, expectations or health problems. It is a dynamic process of an interaction with the aim of establishing a common agenda based on a personal relationship and mutual trust in order to meet the patient's needs. It usually takes place on the doctor's premises.
CONTACT, DIRECT A face-to-face encounter with a patient. Also used to mean a mode of transmission from an infected source, without an intermediate person as vector.
CONTACT, INDIRECT A communication with a patient other than by face-to-face contact. In primary care this is most often by letter, telephone or through a third party. Also used to mean a mode of transmission where other persons or vectors are involved.
CONTACT, INFECTIOUS (Syn: disease contact) A person who has been in association with an infected person, animal or contaminated environment and is now carrying the infection.
CONTACT, PRIMARY The first direct contact between a patient and the health care services in the course of an episode. Also used to mean persons in direct contact with a patient who has a communicable disease.
CONTACT, PROBLEM A patient-provider transaction with regard to one problem. There may be several problem contacts during each encounter. See ENCOUNTER.
CONTINUING CARE Health care devoted to the appropriate follow-up of acute episodes and chronic health problems.
CONTINUING MEDICAL EDUCATION (CME) is the education that should help established specialists improve their performance and patients health outcomes.
CONTINUING PROFESSIONAL DEVELOPMENT (CPD): sometimes means Continuing medical education (CME), also means the process of lifelong learning for all to meet the needs of patients and deliver NHS priorities. There are three elements. The identification of learning needs, the prioritization of the needs, and matching the prioritized needs to learning opportunities.
CONTINUITY OF CARE Health care in which the patient sees the same health care provider at each encounter or for the same health problem and thus identifies the health care provider principally responsible for that care. See PERSONAL CARE.
CONTINUOUS QUALITY . Using improvement knowledge to execute change. This usually involves asking 5 questions before you plan a change. What are you trying to achieve? What do you either know or need to know about this subject to plan change? How will you know if the proposed change is an improvement? What changes can you make? How will you continue the improvement in a cycle of feedback and change?
CONTROL EVENT RATE: CER
CONTROLLED CLINICAL TRIAL A clinical trial in which patients receiving the test treatment are matched and compared to others (controls) who receive a different or no treatment.
CONVERSION STRUCTURE See LINKAGE.
COOP/WONCA CHARTS (Syn: Dartmouth COOP Functional Health Assessment Charts/WONCA) Functional health assessment charts which have been developed for use in primary care patients. The charts are designed to measure physical fitness, feelings, daily activities, social activities, change in health and overall health. See also HEALTH OUTCOME MEASURES, FUNCTIONAL STATUS INDEX.
CORE The essential part of a collection of entities or classes.
CORE CITIES: Core cities are eight major regional cities in England: Birmingham, Bristol, Leeds, Liverpool, Manchester, Newcastle, Nottingham and Sheffield. The city councils of these cities began working together in the early1990s to set out a vision of the distinctive role that big cities must play in national and regional life in the new century. These cities subsequently agreed to formalise their association and became ‘the English Core Cities Group’ in 1995. http://www.corecities.com/coreDEV/coreindex.htm http://www.corecities.com/coreDEV/cityprosps/Bris.pdf
CORE CURRICULUM. The essential basic knowledge that all GPs should possess.
CORRELATION COEFFICIENT A measure of association that indicates the degree to which two variables have a linear relationship. This coefficient, called r, can vary between + 1 and -1; when r= + 1, there is a perfect positive linear relationship in which one variable varies directly with the other. When r=-1, there is a perfect negative linear relationship between the variables. The measure can be generalized to quantify the degree of linear relationship between one variable and several others: multiple correlation coefficient.
CORRELATION The degree to which variables change together.
COST CONTAINMENT A strategic plan intended to control costs.
COST The price which must be paid, whether in objective (i.e. money or resources) or subjective (i.e. distress, discomfort) terms in achieving an objective. 1. Direct: those costs incurred by patients, families and society to provide the health care service. 2. Indirect: all other costs related to the condition or treatment under study.
COST-BENEFIT ANALYSIS A form of economic assessment, usually from society's perspective, in which the costs of medical care are compared with the economic benefits of the care, with both costs and benefits expressed in units of currency. The benefits typically include reductions in future health costs and increased earnings due to improved health of those receiving the care.
COST-EFFECTIVENESS ANALYSIS This analysis seeks to determine both the cost and the effectiveness of an activity, or compare alternative activities to determine the degree to which they will obtain the goals. The preferred action is one that requires the least cost to produce a given level of effectiveness, or provides the greatest effectiveness for a given level of cost. The outcome can be measured in terms of health status.
COST-UTILITY ANALYSIS An economic analysis in which outcomes are measured in terms of their social value.
COT – consultation observation tool is a formative assessment. This is designed to be used by trainers as an evidence collecting instrument. It takes its basis from the summative assessment/MRCGP video assessment. This will usually be used 4 times in ST3
COURSE OVER TIME The duration of an episode as defined by the involvement by the doctor. j 1. The course over time of an episode is acute when less than four weeks are involved. See ACUTE. 2. The course over time is subacute, when more than four weeks, but less than six months within a registration year are involved. See SUBACUTE. The course over time is chronic when during more than six of twelve registration months of a year the general practitioner pays active attention to the episode. See CHRONIC.
COVERAGE A measure of the extent to which the services provided cover the potential need for these services in a community. It is expressed as a proportion in which the numerator is the number of services provided, and the denominator is the number of instances in which the service should have been provided.
CPD see Continuing Professional Development (CPD)
CPEP see Clinical Practice Evaluation Programme (CPEP).
CQI see Continuous Quality Improvement (CQI)
CRITERIA BASED EXAMINATION: Success in an assessment is based on achievement of explicit criteria (see norm and peer based), eg you pass if you achieve more 50% of the total marks available, this means that it is possible for all candidates might pass or all the test.
CRITERIA Predetermined elements against which aspects of quality of medical service, i.e. the performance of a doctor or a practice in a guideline or clinical protocol, may be measured. It can contain both performance and a level to which it will be achieved. The level to be achieved is a standard 1. Implicit: unspecified criteria that is used when medical service is reviewed. 2. Explicit: specified criteria against which a professional performance is compared.
CROCHETS, an unexplainable dislike for certain words, phrases, actions or objects.
CROSS-CULTURAL STUDY A study in which populations from different cultural backgrounds are compared.
CROSS-SECTIONAL STUDY (Syn: transversal) The sampling of patients, or whatever units under study, at one point in time. See: COHORT STUDY, CASE STUDY, CASE CONTROL STUDY.
CSA – Clinical skills assessment. This is an externally applied assessment . The CSA is 'an assessment of a doctor's ability to integrate and apply clinical, professional, communication and practical skills appropriate for general practice'. Role players will act as patients with evaluation by experienced assessors. AKT Applied knowledge test
CUMULATIVE DEATH RATE The proportion that dies over a specified time interval. It may refer to all deaths or deaths from specific cause(s).
CUMULATIVE INCIDENCE The proportion of a group of people who experience the onset of a health problem during a specified time interval. The interval is generally the same for all people in the group.
CURIOSITY, the ability to wonder