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CCAC Quality Improvement Plans – Glossary of Terms

This glossary provides a description of the terms commonly used in Quality Improvement Plans (QIP).

Care Coordinator

Care Coordinators are regulated health professionals with expertise in nursing, social work, occupational therapy, physiotherapy or speech therapy, who work directly with patients in hospitals, doctor's offices, communities, schools and in patients' homes. Care Coordinators work in partnership with community agencies, arranging in-home and community supports and provide information and referral to connect a patient and family to appropriate health and community resources.

 

Client and Caregiver Experience Evaluation (CCEE)

The CCEE is a patient and caregiver experience survey that is conducted on a quarterly basis by an independent third party organization. Patients and caregivers are surveyed to rate their experiences related to their home and community care and service provider organization services. The CCEE is conducted across Ontario for home and community care.

 

CHRIS

The Client Health Related Information System (CHRIS) is an information system used by all Local Health Integration Networks across the province.  It was designed to provide Care Coordinators and administrators with a common system to enter and track patient information. 

 

Hospital Readmission

Patients who've experienced an unplanned admission to the hospital within 30 days of discharge from the hospital as an inpatient.

 

Missed Visit

A "missed visit" refers to a circumstance where the service provider fails to attend a visit to a patient authorized by us as part of the service plan and the service provider is unable to reschedule the visits in accordance with the service plan, except in situations of inclement weather or where the patient is refusing to reschedule within the service plan.

 

Personal Support Providers

Personal support providers are health care agencies that have a contract with the Local Health Integration Networks to provide personal support services.

 

Personal Support Services (PSS)

Personal support services focus on helping patients with personal care and activities of daily living such as bathing, dressing or walking.

 

RAI-HC Assessment

The Resident Assessment Instrument - Home Care (RAI-HC) is a common, reliable, person-centered assessment tool that informs and guides comprehensive care and service planning in community-based settings.

 

Rapid Response Nurse (RRN)

Rapid Response Nurses (RRNs) perform a vital function in our network of health-care services. By facilitating smooth transitions from hospital to home, they act as a bridge to support patients with complex and high care needs. RRNs visit eligible patients at home within 24-48 hours of hospital discharge to ensure that the patient is safely settled at home, that connections to appropriate community or home-based services are made and follow-up appointments are scheduled. The Rapid Response Nursing Program operates 7 days a week.

 

Service Plan/Care Plan

A service plan is a care plan that is created in partnership by the Care Coordinator, the patient, their family and caregivers and is based on the patient's unique needs. The plan of care is completely individual and geared towards achieving a patient's optimal health and wellness at home and in the community. The plan may include home care services directly through the CCACs or through service provider partners or support through additional community resources.

 

Service Provider Organization (SPO)

Organizations that have a contract and partner with us to provide patient care.

 

Timed Up and Go Test (TUG)

Timed Up and Go Test (TUG) is a simple test used to assess a person's mobility.  It measures the time that a person takes to rise from a chair, walk three meters, turn around, walk back to the chair, and sit down. The TUG is used frequently in the elderly population and is a good predictor of risk of falling.

 

Unplanned Emergency Department Visits

This refers to home and community care patients who've experienced an unexpected visit to the hospital Emergency Department within 30 days of discharge from the hospital as an inpatient.