[DM/URSA-CORE] Data Mart for Hospital Inpatient Admission Encounters

Object Description

One record per hospital inpatient admission encounter, including, if they occur prior to inpatient admission, ED visits and/or observation stays.

Metadata

• Table Name: ursa.dm_ursa_core_002
• Layer: DATA_MART
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Encounter ID
• Event Date: Encounter Start Date
• Primary Key: Encounter ID

Published Fields

• Data Model Keys

  • Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
  • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
  • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
  • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
  • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
  • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
  • Primary HCPCS Procedure Provider ID
  • Prior Hospital IP Encounter ID

• Date Fields

  • Encounter Start Date
  • Encounter Patient Inpatient Status Start Date
  • Encounter End Date
  • Encounter Start Date Day of Week
  • Inpatient Status Start Date Day of Week
  • Encounter End Date Day of Week
  • Prior Hospital IP Encounter End Date
  • Elapsed Days from Prior Hospital IP Encounter End Date
  • Is Hospital IP Discharge in Prior 30 Days

• Encounter Fields

  • Ursa Hospital Admission Condition-Treatment Type Tier 1 Category
  • Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Maternity
  • Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Behavioral Health
  • Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Surgical
  • Is Ursa Hospital Admission Condition-Treatment Type Tier 1 Medical
  • Inpatient LOS Category Tier 1
  • Is Inpatient LOS < 2 Midnights
  • Inpatient LOS in Elapsed Midnights
  • Inpatient LOS in Distinct Calendar Days
  • Is Emergency Department Visit Parent Encounter
  • Is Observation Stay Parent Encounter
  • Is Discharge Status Home or Home with Home Health
  • Is Routine Discharge Home
  • Is Discharged Home with Home Health

• Clinical Services Fields

  • Is Surgery Encounter -- Indicates an encounter in which the patient underwent surgery; identified by the presence, among the documents associated with an encounter, of a surgical HCPCS code or a revenue center code for operating room setting care.
  • Is Prior Hospital IP Admit Surgery Encounter
  • Primary HCPCS Procedure HCPCS Code
  • Primary HCPCS Short Description
  • Primary HCPCS Long Description
  • Is Primary HCPCS Procedure Surgical
  • Primary HCPCS AHRQ CCS Single-Level Procedure Category Code
  • Primary HCPCS AHRQ CCS Single-Level Procedure Category Description
  • Principal ICD Procedure ICD-10-PCS Code
  • Principal ICD Procedure ICD-10-PCS Description
  • Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Code
  • Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Description
  • Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Code
  • Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Description

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Prior Admit Principal Discharge Diagnosis ICD-10-CM Code
  • Prior Admit Principal Discharge Diagnosis ICD-10-CM Description
  • Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
  • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
  • Discharge Diagnosis WHO ICD-10 Chapter Description
  • Discharge Diagnosis WHO ICD-10 Block Description

• Insurance Fields

  • Encounter Primary Payor Description
  • Encounter Primary Plan Description
  • Encounter Primary Plan Financial Class Description
  • Is Encounter Primary Plan Financial Class Commercial
  • Is Encounter Primary Plan Financial Class Medicare FFS
  • Is Encounter Primary Plan Financial Class Medicare Advantage
  • Is Encounter Primary Plan Financial Class Medicaid

• Provider Fields

  • Facility Provider Description
  • Facility Provider Primary NUCC Provider Taxonomy Code
  • Facility Provider Primary NUCC Provider Taxonomy Description
  • Facility Provider State Abbreviation
  • Facility Provider ZIP Code 5-Digit
  • Attending Provider Description
  • Attending Provider Primary NUCC Provider Taxonomy Code
  • Attending Provider Primary NUCC Provider Taxonomy Description

• Billing and Claims Fields

  • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
  • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
  • MS-DRG MDC Code
  • MS-DRG MDC Description
  • Is CMS DRG Medical-Surgical Type Surgical
  • Is CMS DRG Medical-Surgical Type Medical
  • CMS DRG Weight
  • APR-DRG Code -- The standard 3-digit All Patient Refined Diagnosis Related Group code; APR-DRG codes should include leading zeros, and do not include the Severity of Illness or Risk of Mortality modifiers.
  • APR-DRG Description -- The natural language description of a standard 3-digit All Patient Refined Diagnosis Related Group code. (See also [URSA-CORE] APR-DRG Code)
  • APR-DRG MDC Code -- The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Description)
  • APR-DRG MDC Description -- The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Code)
  • APR-DRG Severity of Illness Code -- The standard 1-digit Severity of Illness modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as SOI.
  • APR-DRG Risk of Mortality Code -- The standard 1-digit Risk of Mortality modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as ROM.
  • Is APR-DRG Medical Surgical Type Medical -- Indicates the APR-DRG has been classified as a medical (non-surgical) code.
  • Is APR-DRG Medical Surgical Type Surgical -- Indicates the APR-DRG has been classified as a surgical code.
  • CMS Admit Type Code -- The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.
  • CMS Admit Type Description
  • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • CMS Admit Source Description
  • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
  • CMS Place of Service Description
  • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.
  • CMS Patient Discharge Status Description

• Financial Fields

  • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
  • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

• Metadata Fields

  • Calculated MS-DRG Mean Length of Stay in Calendar Days
  • Relative Change of Encounter LOS to Calculated MS-DRG Mean
  • Calculated APR-DRG Mean Length of Stay in Calendar Days
  • Relative Change of Encounter LOS to Calculated APR-DRG Mean
  • CMS DRG Arithmetic Mean LOS -- The arithmetic mean length of stay (ALOS) is the average length of stay experienced by a patient within a chosen DRG. (See also [URSA-CORE] CMS DRG Geometric Mean LOS)
  • Relative Change of Encounter LOS to CMS MS-DRG Arithmetic Mean
  • CMS DRG Geometric Mean LOS -- The geometric mean length of stay or (GMLOS) is the national mean length of stay for each diagnostic related grouper (DRG) as determined and published by CMS. The geometric mean reduces the effect of very high or low values, which might bias the mean if a straight average (arithmetic mean) is used. (See also [URSA-CORE] CMS DRG Arithmetic Mean LOS)
  • Relative Change of Encounter LOS to CMS MSDRG Geometric Mean

Foreign Keys

• pat_id → ursa.no_ursa_core_pat_001.pat_id
• enc_primary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• enc_primary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• attending_prov_id → ursa.no_ursa_core_prov_001.prov_id
• primary_hcpcs_proc_prov_id → ursa.no_ursa_core_prov_001.prov_id
• enc_id → ursa.so_ursa_core_enc_001.enc_id