[DM/URSA-PHU] Data Mart for Potentially Preventable Hospital Encounters

Object Description

One row for each high probability avoidable ED visit or potentially preventable hospital inpatient admission; the latter includes ambulatory care sensitive admissions and admissions following a prior related encounter).

Metadata

• Table Name: ursa.dm_ursa_phu_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)
  • 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)
  • Prior Admission Facility Provider ID
  • Prior ED Visit Facility Provider ID
  • Prior SNF Stay Facility Provider ID

• Date Fields

  • Encounter Start Date
  • Encounter End Date

• Encounter Fields

  • PPHE Category
  • Is ACS Hospital Inpatient Admission
  • Is Hospital Inpatient Admission with Prior Related Encounter
  • Is High Probability Preventable ED Visit with Inpatient Admission
  • Is High Probability Preventable ED Visit without Inpatient Admission
  • ACS Admission PQI Category
  • Prior Encounter Scenario Category -- A hospital inpatient admission with one or more of the following: (1) prior ED visit within 7 days prior to admission; (2) prior hospital inpatient admission with discharge date within 7 days prior to admission or within 30 days prior to admission and with similar principal discharge diagnoses; or (3) prior SNF stay with discharge date within 14 days prior to admission.
  • Preventable ED Visit Scenario Category
  • Encounter LOS in Elapsed Midnights
  • Is Encounter LOS < 2 Midnights
  • Encounter LOS Category Tier 1
  • Encounter LOS in Distinct Calendar Days

• Provider Fields

  • Facility Provider NPI
  • Facility Provider Description
  • Facility Provider NUCC Taxonomy Code
  • Facility Provider Primary NUCC Provider Taxonomy Description
  • Facility Provider State Abbreviation
  • Facility Provider ZIP Code 5-Digit
  • Prior Admission Facility Provider Description
  • Prior ED Visit Facility Provider Description
  • Prior SNF Stay Facility Provider Description

• Diagnosis Fields

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

Terms

• PPHE: A potentially preventable hospital encounter; defined as any of the following: (1) an ambulatory care sensitive hospital inpatient admission; (2) a hospital inpatient admission with a prior related encounter; or (3) a high-probability avoidable ED visit.

Foreign Keys

• enc_id → ursa.so_ursa_phu_enc_004.enc_id
• pat_id → ursa.no_ursa_core_pat_001.pat_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• prior_admission_facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• prior_ed_visit_facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• prior_snf_stay_facility_prov_id → ursa.no_ursa_core_prov_001.prov_id