Crude Rate: The number of events or occurrences of disease in a given time period divided by the population at risk for that event or disease over the same time period.

Age-adjusted Rate (Direct Method): A weighted average of the age-specific incidence or mortality rates from the targeted population(s) where the weights are the proportions of persons in the corresponding age groups of a standard population. In this document, the Year 2000 US population is used as the standard population. Calculating an age-adjusted rate allows for comparisons across targeted populations after accounting or "adjusting" for possible differences in the age-distribution of these populations.

Chronic Confusion or Dementing Illness Units¹: "Chronic Confusion or Dementing Illness" is a special license classification for nursing facilities or a special unit within such a facility providing care to persons who suffer from chronic confusion or dementing illness. Reference to Chronic Confusion of Dementing Illness Units is made in the acts and joint resolutions of the 1990 regular session of the Seventy-Third General Assembly of the State of Iowa.

Emergency Medical Technician – Basic²: The EMT-B course emphasizes the development of student skills in patient assessment and examination; the recognition of signs and symptoms of illness or injury; proper procedures when rendering emergency medical care including patient assisted medications, automated external defibrillation, maintenance of a non-medicated IV, and the use of an advanced airway device. General topics covered include: human anatomy and physiology, bleeding and shock, bandaging and splinting, medical/behavioral emergencies, obstetrics/gynecology, extrication from automobiles, farm, industrial and environmental emergencies, and ambulance operations.

Emergency Medical Technician – Intermediate²: The EMT-I course involves additional training in patient assessment, intravenous therapy, advanced airway management techniques and automated defibrillation.

Emergency Medical Technician – Paramedic²: The Paramedic level is the highest EMS certification obtainable. This level covers additional emergency medical care skills including cardiac evaluation and treatment, medication effects and treatment, and advanced airway management techniques.

Fetal Death³:A birth that fails to show any sign of life after delivery. Reportable fetal deaths in Iowa are those greater than 20 weeks gestation. The responsibility for determining if a birth meets this definition is that of the attending physician. "Fetal death" and "stillbirth" are synonymous terms.

First Responder²: The First Responder course is designed to train the student in patient stabilizing techniques and basic emergency medical care prior to the arrival of an ambulance. Skills in this program include patient assessment, vital signs, automated external defibrillation, oxygen delivery, and use of an advanced airway device.

Hospital¹: Any place which is devoted primarily to the maintenance of facilities for the diagnosis, treatment or care of two or more non-related individuals suffering from illness, injury or deformity for a period exceeding 24 hours. It is also a place which is devoted primarily to the rendering of obstetrical or other medical/nursing care for two or more non-related individuals for a period exceeding 24 hours. It can be any institution, place, building or agency in which any accommodation is primarily maintained, furnished or offered for the care of two or more non-related aged or infirmed persons requiring or receiving chronic or convalescent care for a period exceeding 24 hours. Hospitals shall include sanitariums or other related institutions within the meaning of the federal Hill-Burton Act. A hospital shall include, in any event, any facilities wholly or partially constructed, or constructed with federal assistance pursuant to Public Law 725, 79th Congress, approved August 13, 1946. Definition is found in Title 42 in the Code of Federal Regulations and 135J of the Iowa Administrative Code.

Infant Death³: Death of a liveborn infant under one year of age. Includes both neonatal and postneonatal deaths.

Intermediate Care Facilities for the Mentally Retarded¹: Institutions or distinct parts of institutions whose primary purpose is to provide health or rehabilitative services to three or more individuals who primarily have mental retardation or a related conditions. Intermediate Care Facilities for the Mentally Retarded must meet the requirements of Iowa Code Chapter 135C and federal standards codified in 42 United States Code 1936d, which is contained in Title 42 of the Code of Federal Regulations, Part 483, Subpart D, 410-480. Definition is found in Chapter 135C of the Code of Iowa.

Intermediate Care Facilities for Persons with Mental Illness¹: Institutions, places, buildings or agencies whose primary purpose is to provide accommodation, board and nursing care for a period exceeding 24 consecutive hours to three or more individuals who primarily have mental illness. Definition is found in Chapter 135C of the Code of Iowa.

Kessner Index: A system to classify prenatal care as adequate, intermediate, or inadequate. It is derived from the Institute of Medicine’s Three-Factor Prenatal Care Index⁴. The index measures adequacy of prenatal care based upon 1) trimester of entry, 2) number of prenatal visits, and 3) gestational age of infant at birth. The gestation weeks are calculated by subtracting the last menstrual date from the child's birth date. If the last menstrual date is missing from the birth record, the doctor's (or other medical professional's) estimate of gestation is used. The accuracy of the level of prenatal care is as reliable as the information provided by the mother and her caregiver.

                                        GESTATION           NUMBER OF
PRENATAL CARE                           (WEEKS)             PRENATAL VISITS

ADEQUATE (includes women who            13 or less          1 or more or not stated
started their first prenatal            14-17               2 or more
visits within the first                 18-21               3 or more
three months of pregnancy)              22-25               4 or more
                                        26-29               5 or more
                                        30-31               6 or more
                                        32-33               7 or more
                                        34-35               8 or more
                                        36 or more          9 or more

INADEQUATE (includes women              14-21               0 or unstated
who started care within                 22-29               1 or less or unstated
the third trimester)                    30-31               2 or less or unstated
                                        32-33               3 or less or unstated
                                        34 or more          4 or less or unstated
                                        not stated

INTERMEDIATE                            all combinations not stated above

Live Birth³: A birth that shows any sign of life after delivery. The World Health Organization considers a sign of life as being the breathing or showing of any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. The responsibility for determining if a birth meets this definition is that of the attending physician.

Neonatal Death³: Death of a liveborn infant occurring within the first 27 days of life.

Nursing Facilities¹: Institutions or distinct parts of institutions housing three of more individuals for a period exceeding 24 consecutive hours, whose primary purpose is to provide health-related care and services, including rehabilitation, for individuals who because of mental or physical condition, require nursing care and other services in addition to room and board. Nursing facilities do not engage primarily in providing treatment or care for mental illness or mental retardation. Definition is found in Chapter 135C of the Code of Iowa.

Perinatal Death³: Death of a fetus of greater than 20 weeks gestation or death of a liveborn infant under 28 days of life.

Primary Care Physicians: Includes Family Practice, Internal Medicine, Pediatric, and Obstetrics/Gynecology physicians.

Residential Care Facilities¹: Institutions, places, buildings, or agencies providing accommodation, board, personal assistance and other essential daily living activities for a period exceeding 24 consecutive hours. Individuals living in a residential care facility are unable to sufficiently or properly care for themselves because of illness, disease, or physical or mental infirmity, but do not require the services of a registered or licensed practical nurse, except for emergencies. Definition is found in Chapter 135C of the Code of Iowa.

Residential Care Facilities for the Mentally Retarded and Specialized 3-5 Bed Facilities¹: Facilities that provide accommodation, board, personal assistance, essential activities of daily living and habilitative services to three of more individuals with mental retardation. Residents of a Residential Care Facility for the Mentally Retarded are unable to sufficiently or properly care for themselves, but do not require the services of a registered or licensed practical nurse. The specialized license is for Residential Care Facilities which serve persons with mental retardation, chronic mental illness and other developmental disabilities having five or fewer residents as specified in Iowa Code Section 225C.26. The facility is exempt from Iowa Code Section 135.63. Definition is found in Chapter 135C of the Code of Iowa.

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