URSA-ACOREACH-ACR: Unplanned All-Condition 30-Day Readmissions (ACR)

  • Published on Aug 21, 2025
  • 6 minute(s) read
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Measure Description

Among qualifying hospital inpatient admissions for non-cancer, non-psychiatric, and non-rehabilitation conditions, the percentage with an unplanned all-condition readmission within 30 days of discharge.

Metadata

  • Measure Type: Rate Measure
  • Temporal Structure: Entity
  • Component Class: Normal-Form
  • Denominator Case Field: Primary Encounter ID
  • Target Direction: Down

Denominator Description

Qualifying hospital inpatient admissions for non-cancer, non-psychiatric, and non-rehabilitation conditions.

Numerator Description

Qualifying denominator cases with a qualifying follow-up visit within the appropriate time frame, as defined by the chronic condition and acuity level of the exacerbation.

Published Fields

  • Data Model Keys

    • Facility Provider ID
    • Patient ID
    • Primary Plan Attributee Provider ID
    • Primary Plan Attributee Individual Provider ID
    • Primary Plan Attributee Provider Group Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID
    • Primary Payor ID
    • Primary Plan ID
    • Last Continuous Primary Payor Membership Episode Payor ID
    • Next Continuous Primary Payor Membership Episode Payor ID
    • Readmission Facility Provider ID
    • Readmission Primary Encounter ID

  • Patient Fields

    • Is Patient Alive
    • Is Hospice in Last 12 Months
    • Patient Last Name
    • Patient Date of Birth
    • Patient Age Integer
    • Patient Age Category Tier 1
    • Patient Age Category Tier 2
    • Patient Sex Category
    • Is Patient Sex Female
    • Is Patient Sex Male
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months
    • PCP Attribution Category
    • Primary Care Engagement Category
    • Count Primary Care Visits in Last 36 Months
    • Specialty Care Engagement Category
    • Count Specialty Care Office Visits in Last 36 Months
    • Primary or Specialty Care Engagement Category
    • Count Clinician Office Visits in Last 3 Years

  • Date Fields

    • Primary Encounter Start Date
    • Primary Encounter End Date
    • Period Start Date
    • Period End Date
    • Current Continuous Primary Payor Membership Episode Start Date
    • Current Continuous Primary Payor Membership Episode End Date
    • Current Non-Membership Episode Start Date
    • Current Non-Membership Episode End Date
    • Last Continuous Primary Payor Membership Episode Start Date
    • Last Continuous Primary Payor Membership Episode End Date
    • Next Continuous Primary Payor Membership Episode Start Date
    • Next Continuous Primary Payor Membership Episode End Date
    • Current Continuous Medical Claim Data Coverage Episode Start Date
    • Current Continuous Medical Claim Data Coverage Episode End Date
    • Current Continuous Pharmacy Claim Data Coverage Episode Start Date
    • Current Continuous Pharmacy Claim Data Coverage Episode End Date
    • Readmission Primary Encounter Start Date
    • Readmission Primary Encounter End Date
    • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
    • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
    • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

  • Encounter Fields

    • Is Emergency Department Visit Parent Encounter Document
    • CMS Admit Source Code
    • CMS Patient Discharge Status Code

  • Provider Fields

    • Facility Provider NPI
    • Facility Provider CCN
    • Facility Provider Description
    • Primary NUCC Provider Taxonomy Code
    • Primary NUCC Provider Taxonomy Description
    • Primary Plan Attributee Provider Description
    • Primary Plan Attributee Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Individual Provider Description
    • Empirical Attributee Primary Care Individual Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Provider Group Provider Description
    • Empirical Attributee Primary Care Provider Group Primary NUCC Provider Taxonomy Description
    • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
    • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

  • Location Fields

    • Patient State Abbreviation
    • Patient ZIP Code 5-Digit
    • Patient County Description
    • UW HIP Area Deprivation Index National Percentile
    • UW HIP ADI Quintile Category
    • UW HIP ADI Decile Category
    • CDC SVI Overall Quintile Category
    • CDC SVI Socioeconomic Quintile Category
    • CDC SVI Household / Disability Quintile Category
    • CDC SVI Minority / Language Quintile Category
    • CDC SVI Housing / Transportation Quintile Category

  • Insurance Fields

    • Is Any Current Plan Membership
    • Is Patient with Multiple Active Plan Memberships
    • Count Active Plan Memberships
    • Primary Payor Description
    • Primary Plan Description
    • Primary Plan Employer Description
    • Primary Plan Financial Class Description
    • Is Primary Plan Financial Class Commercial
    • Is Primary Plan Financial Class Medicare Advantage
    • Is Primary Plan Financial Class Medicare FFS
    • Is Primary Plan Financial Class Medicaid
    • Is Primary Plan Financial Class Other
    • Is Primary Plan Coverage Type Medical
    • Is Primary Plan Coverage Type Pharmacy
    • Is Any Plan Coverage Type Medical
    • Is Any Plan Coverage Type Pharmacy
    • Is Any Plan Financial Class Commercial
    • Is Any Plan Financial Class Medicare FFS
    • Is Any Plan Financial Class Medicare Advantage
    • Is Any Plan Financial Class Medicaid
    • Is Any Plan Financial Class Other
    • Member HICN
    • Member MBI
    • Is CMS ESRD Status
    • Is CMS Hospice Status
    • Is Dual Medicare-Medicaid Enrolled
    • CMS Dual Status Code
    • Member Medicaid Number

  • Clinical Services Fields

    • Principal ICD-10-PCS Code
    • Principal ICD-10-PCS Description

  • Diagnosis Fields

    • Principal Discharge Diagnosis ICD-10-CM Code
    • Principal Discharge Diagnosis ICD-10-CM Description
    • CCW Count Category
    • Count CCW Conditions
    • Is CCW Acquired Hypothyroidism
    • Is CCW Acute Myocardial Infarction
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
    • Is CCW Alzheimers Disease
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
    • Is CCW Anemia
    • Is CCW Anxiety Disorders
    • Is CCW Asthma
    • Is CCW Atrial Fibrillation
    • Is CCW Autism Spectrum Disorder
    • Is CCW Benign Prostatic Hyperplasia
    • Is CCW Bipolar Disorder
    • Is CCW Blindness and Visual Impairment
    • Is CCW Breast Cancer
    • Is CCW Cataract
    • Is CCW Cerebral Palsy
    • Is CCW CKD
    • Is CCW Colorectal Cancer
    • Is CCW COPD and Bronchiectasis
    • Is CCW Cystic Fibrosis and Other Metabolic Disorder
    • Is CCW Deafness and Hearing Impairment
    • Is CCW Depression
    • Is CCW Depressive Disorders
    • Is CCW Diabetes
    • Is CCW Endometrial Cancer
    • Is CCW Epilepsy
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue
    • Is CCW Glaucoma
    • Is CCW Heart Failure
    • Is CCW Hip or Pelvic Fracture
    • Is CCW Hyperlipidemia
    • Is CCW Hypertension
    • Is CCW Intellectual Disability
    • Is CCW Ischemic Heart Disease
    • Is CCW Learning Disability
    • Is CCW Leukemia
    • Is CCW Lung Cancer
    • Is CCW Migraine and Chronic Headache
    • Is CCW Mobility Impairment
    • Is CCW Multiple Sclerosis
    • Is CCW Muscular Dystrophy
    • Is CCW Obesity
    • Is CCW Osteoporosis
    • Is CCW Other Developmental Delay
    • Is CCW Personality Disorder
    • Is CCW Pressure or Chronic Ulcer
    • Is CCW Prostate Cancer
    • Is CCW PTSD
    • Is CCW PVD
    • Is CCW Rheumatoid Arthritis or Osteoarthritis
    • Is CCW Schizophrenia
    • Is CCW Schizophrenia or Other Psychotic Disorders
    • Is CCW Stroke or Transient Ischemic Attack
    • CCW Systems Category
    • Count CCW Systems
    • Is CCW System Behavioral Health
    • Is CCW System Cardiovascular
    • Is CCW System Congenital
    • Is CCW System Endocrine/Metabolic
    • Is CCW System Genitourinary
    • Is CCW System Hematologic
    • Is CCW System Musculoskeletal
    • Is CCW System Neurological
    • Is CCW System Oncologic
    • Is CCW System Ophthalmologic
    • Is CCW System Pulmonary
    • Is CCW System Other

  • Denominator Fields

    • ACR Cohort Description
    • Is Age 65+

  • Numerator Fields

    • Readmission Facility Provider NPI
    • Readmission Facility Provider CCN
    • Readmission Facility Provider Description
    • Is Readmission Facility CCN Type Short-Term General or Specialty Hospital
    • Readmission Principal Discharge Diagnosis ICD-10-CM Code
    • Readmission Principal Discharge Diagnosis ICD-10-CM Description

  • Metadata Fields

    • Random Integer 1 to 1000
    • Is Any Current Data Coverage
    • Count Distinct Data Sources
    • Is Medical Claim Data Coverage
    • Is Institutional Claim Data Coverage
    • Is Institutional Claim Paid Amount Data Coverage
    • Is Institutional Claim Service Line Item Paid Amount Data Coverage
    • Is Professional Claim Data Coverage
    • Is Professional Claim Paid Amount Data Coverage
    • Is Professional Claim Service Line Item Paid Amount Data Coverage
    • Is Pharmacy Claim Data Coverage
    • Is Pharmacy Claim Paid Amount Data Coverage

  • Validation Only Fields

    • Continuous Membership Criterion Period End Date
    • Continuous Membership Criterion Period Start Date

  • Measure Fields

    • Denominator
    • Numerator

  • Module Fields

    • Is Continuous Membership Criterion Met
    • Next Encounter Facility Provider ID
    • Next Encounter Start Date
    • Elapsed Days from Encounter End Date to Next Encounter Start Date
    • Is Facility CCN Type Short-Term General or Specialty Hospital
    • Is Facility CCN Type Critical Access Hospital
    • Is Facility CCN Type Rehabilitation Hospital or Unit
    • Is Facility CCN Type Psychiatric Hospital or Unit
    • Is Any Planned Admission Procedure
    • Is Any Potentially Planned Admission Procedure
    • Is Acute Illness or Complication Principal Diagnosis