Acronym	Definition
AA	Aortic aneurysm
ADE	Adverse drug events
AFIB	Atrial fibrillation
AHA	American Hospital Association
AHRQ	Agency for Healthcare Research and Quality
AMI	Acute myocardial infarction
ARCHI	A&M Rural & Community Health Institute
C.Diff/CDI	Clostridium difficile
CAC	Children’s asthma care
CAH	Critical access hospital
CAH-QI	Critical Access Hospital Quality Improvement Program
CAP	Community-acquired pneumonia
CART	CMS Abstraction and Reporting Tool
CAUTI	Catheter-associated urinary tract infection
CCN	CMS certification number
CDC	Centers for Disease Control and Prevention
CDE	Common duct exploration
Chole	Cholecystectomy
CLABSI	Central line-associated blood stream infection
CMS	Centers for Medicare & Medicaid Services
COPD	Chronic obstructive pulmonary disease
CQM	Clinical quality measure
CT	Computerized tomography
DACA	Data Accuracy and Completeness Acknowledgement
Domain	The category where MBQIP Measures belong. There are 4 main mbqip domains: Care Transitions, Outpatient, Patient Engagement, and Patient Safety/Inpatient
DVT	Deep vein thrombosis
ECG	Electrocardiogram
eCQM	Electronic clinical quality measure
ED	Emergency department
EDHI	Early hearing detection and intervention
EDTC	Emergency Department Transfer Communication
EHR	Electronic health record
EMS	Emergency medical service
ESI	Emergency Severity Index
ESRD	End Stage Renal Disease
Flex	Medicare Rural Hospital Flexibility Program
FORHP	Federal Office of Rural Health Policy
FY	Fiscal year
GI	Gastrointestinal
HAI	Healthcare-associated infections
HCAHPS	Hospital Consumer Assessment of Healthcare Providers and Systems
HCP	Healthcare personnel
HCP	Influenza Vaccination Coverage Among Health Care Personnel
HIIN	Hospital Improvement and Innovation Network
HIQR	Hospital Inpatient Quality Reporting Program
HF	Heart failure
HIP-KNEE	Total hip arthroplasty and/or total knee arthroplasty
HOQR	Hospital Outpatient Quality Reporting Program
HRET	Health Research & Education Trust
HRSA	Health Resource and Services Administration
HTN	Hypertension
HWR	Hospital-wide all-cause unplanned readmission
ICU	Intensive Care Unit
IMM	Immunization
IQR	Inpatient Quality Reporting
IVAC	Infection-related ventilator-associated complications
IVR	Interactive Voice Response
MBQIP	Medicare Beneficiary Quality Improvement Project
MBQIP-DB	Medicare Beneficiary Quality Improvement Project Database
Measure	The basic unit or component which the MBQIP program keeps track. Measures are divided into two categories: core and additional. Measures are further divided into four domains: patient safety/inpatient, patient engagement, care transitions and outpatient.
MMA	Medicare Prescription Drug Improvement and Modernization Act
MORT	Mortality
MOU	Memorandum of Understanding
MRI	Magnetic Resonance Imaging
MSPB	Medicare spending per beneficiary
MRSA	Methicillin-resistant Staphylococcus aureus
NHSN	National Healthcare Safety Network
NRHRC	National Rural Health Resource Center
NoP	Notice of Participation
ONC	Office of the National Coordinator for Health Information Technology
OP	Outpatient
OP-2	Fibrinolytic Therapy Received Within 30 Minutes
OP-3	Median Time to Transfer to Another Facility for Acute Coronary Intervention
OP-18	Median Time from ED Arrival to ED Departure for Discharged ED Patients
OP-22	Patient Left Without Being Seen
OQR	Outpatient Quality Reporting
P4P	Partnership for Patients
PC	Perinatal Care
PCI	Primary percutaneous coronary intervention
PE	Pulmonary embolism
PN	Pneumonia
PI	Promoting Interoperability
POD	Postoperative day
PPS	Prospective Payment System
PSI	Patient Safety Indicators
QIN-QIO	Quality Innovation Network – Quality Improvement Organization
QIO	Quality Improvement Organization
QMP	Qualified medical professional
QNet	QualityNet
QRDA	Quality reporting document architecture
READM	Readmission
RHIhub	Rural Health Information Hub
RN	Registered nurse
SA	System administrator
SCIP-Inf	Surgical care improvement project-infection
Sfusion	Spinal fusion
SORH	State Office of Rural Health
SSI	Surgical site infection
STEMI	ST-Segment Elevation Myocardial Infarction
THA	Texas Hospital Association
THA	Total hip arthroplasty
THAF	Texas Hospital Association Foundation
TKA	Total knee arthroplasty
UTI	Urinary tract infection
VAE	Ventilator-associated event
VBP	Value-Based Purchasing
VKG	Virtual Knowledge Group
VTE	Venous thromboembolism

Measure Resources

MBQIP Data Abstraction Training Series

This recorded training series is for critical access hospital (CAH) staff with responsibility for data collection of Centers for Medicare & Medicaid Services (CMS) Inpatient and Outpatient quality measures. Pick individual topics that you have questions about, or listen to the full series for a comprehensive overview of the process to identify each measure population and abstract the required data elements. To view with captions, click the "CC" icon in the lower right of the video.

Resources related to specific measures
Name	Last Updated	Description
MBQIP Measures	January 2023	Chart outlining the required and optional MBQIP measures. Measures are broken down into two categories: core and additional and then into four domains: patient safety/inpatient, patient engagement, care transitions, and outpatient. MBQIP is a Medicare Rural Hospital Flexibility (Flex) quality improvement grant program for Critical Access Hospitals.
MBQIP Data Submission Deadlines	January 2023	Updated data submission deadlines.
MBQIP Data Reporting Reminders	March 2023	State Flex Coordinators can tailor this template as needed and send to critical access hospitals (CAHs) reminding them of upcoming data submission deadlines for Medicare Beneficiary Quality Improvement Project (MBQIP) measures, as well as corresponding collection time periods and submission processes.
MBQIP Measures Fact Sheets	October 2021	The Measure Fact Sheets provide an overview of the data collection and reporting processes for current Medicare Beneficiary Quality Improvement Project (MBQIP) Core Measures and MBQIP Additional Measures with federally established means of data collection and reporting. The intended audience for the MBQIP Measures Fact Sheets is critical access hospital personnel involved with quality improvement and/or reporting and state Flex Program personnel.
MBQIP Measure Change Summaries	January 2023	These summaries provide information about measures added and removed from the Medicare Beneficiary Quality Improvement Project (MBQIP) since fall 2017.
Antibiotic Stewardship Core Elements Mapping	August 2020	The National Healthcare Safety Network (NHSN) uses responses from several questions on the Patient Safety Component–Annual Hospital Survey to determine whether a single core element of Antibiotic Stewardship is met. This resource crosswalks questions on the survey to the core element, allowing state Flex programs to do a deeper analysis of the antibiotic stewardship data and identify high performers and opportunities for improvement.
HCAHPS Overview: Vendor Directory	April 2022	This guide, updated April 2022, provides information on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) including the benefits and challenges of implementing an HCAHPS survey process with small rural hospitals, specifically critical access hospitals (CAHs). Identifies vendors to guide small rural hospitals and CAH vendor selection of this important, patient-centered survey process.
National Healthcare Safety Network Annual Survey Resources	January 2018	This document provides instructions for how to access and complete the National Healthcare Safety Network (NHSN) Annual Facility Survey required for reporting Antibiotic Stewardship under the Medicare Beneficiary Quality Improvement Project (MBQIP).