The Stanford Chronic Care Management System


A Glossary of Terms

The following terms have been used throughout this web site. The definitions provided below may be helpful in understanding the meaning and intent of SCCMS.

baseline telephone instruction: Instruction provided to patients by the nurse care manager by telephone as part of the enrollment process. The instruction focuses on all aspects of the patient's subsequent telephone interaction with CMS staff as well as training in the recognition of important cardiovascular symptoms.

behavioral intervention: This refers to the fact that patients' psychological status is an important determinant of their effectiveness in summoning help in the event of cardiovascular symptoms of concern. The nurse care manager trains patients to anticipate and overcome their potential reluctance to seek prompt help.

clinical algorithms: These are the rules that determine the advice provided by CMS staff in response to patients' reports of symptoms of concern. The rules match the intensity of the medical response to the risk of a heart attack. For example, most patients determined to be at low risk by the clinical algorithms will be advised by CMS staff to remain at home rather than attending a same-day clinic or calling 911.

clinical dashboard: This metaphor captures the sense of an interval assessment of a patient's status. The patient's status is generally stable and satisfactory or unstable and unsatisfactory. The dashboard also permits a clinician to view the progress of a population of patients.

criteria for eligibility: The chief criterion for eligibility is the presence of coronary artery disease, which places the patient at an increased risk of a heart attack or sudden cardiac death.

criteria for exclusion: These criteria identify patients unable to interact with CMS staff members to implement the treatment program. Examples of exclusion criteria are mental illness, substance abuse and dementia. Patients with these conditions require specific treatments.

MULTIFIT: This is an acronym for the Multiple Risk Factor Intervention Trial, conducted 1988-1991, which was the first clinical trial conducted by the Stanford Cardiac Rehabilitation Program to incorporate multiple interventions simultaneously to enhance recovery from heart attack.

nurse care manager: A CMS-trained nurse care manager is a registered nurse with specialized training in the management of cardiovascular conditions in outpatients, who usually interacts with patients by telephone.

nurse training course: This course, provided by CMS, permits registered nurses to assume the responsibilities of a nurse care manager.

research assistant: This individual is responsible for telephoning patients at specified intervals to determine patients' satisfaction with CMS and obtain data necessary to establish the patient's medical status. This individual has no role in the intervention process.

telephone contact form: This electronic form captures the telephone interactions between the nurse care manager and the patient, whether these interactions are initiated by the patient or the nurse care manager.

telephone triage: This is the process of providing the appropriate advice to patients reporting symptoms of concern by telephone to the nurse care manager. Based on this interaction and the information available prior to the patient's telephone contact, CMS staff recommend that the patient remains at home, visits a same-day clinic or calls 911 for transportation to an ER.