Minnesota Administrative Rules
Agency 144 - Health Department
Chapter 4685 - HEALTH MAINTENANCE ORGANIZATIONS
QUALITY ASSURANCE
Part 4685.1105 - DEFINITIONS

Subpart 1. Scope.

The following definitions apply to parts 4685.1105 to 4685.1130, unless the context clearly requires another meaning.

Subp. 2. Criteria.

"Criteria" means standards that can be used to determine attainment of quality health care. Criteria may be explicit or implicit. Explicit criteria are a set of norms or indicators that are developed by health care professionals and are predetermined. Implicit criteria are the judgments of health care professionals regarding information related to quality of care.

Subp. 3. Data.

"Data" refers to the following and similar types of information: patient charts, reports, records, enrollee surveys, staff surveys, staff concerns, performance appraisals, research, financial information, observation, professional organization credentialing reviews, and complaints registered.

Subp. 4. Focused study.

"Focused study" means a study that begins with a hypothesis and includes systematic data collection, to provide information to identify or resolve problems or potential problems with quality of care. Focused studies include a written methodology and corrective action strategies when appropriate.

Subp. 5. Monitoring.

"Monitoring" means collection of information relating to quality of care. Monitoring may be in the form of prospective, concurrent, or retrospective audits; reports; surveys; observation; interviews; complaints; peer review; or evaluation of claims or encounter level data.

Subp. 6. Outcome.

"Outcome" means the end result of care, or a change in patient health status. Examples of outcomes of care include a hospital admission or readmission, an advanced stage of a disease, recovery, alleviation of symptoms, or death.

Subp. 7. Process.

"Process" means the nature of events and activities in the delivery of health care.

Subp. 8. Structure.

"Structure" means the institutional or organizational aspects of care. Structure includes the organizing framework that brings the provider and patient together, organizational processes, policies, financial resources, and staff qualifications.