URSA-CKD-104: Nephrologist Visit 180+ Days Prior to Dialysis

Measure Description

Among instances of ESRD dialysis starts, the percentage with a nephrology provider clinician office visit within 180 to 360 days prior

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Encounter ID
• Target Direction: Up

Denominator Description

ESRD starts with dialysis

Numerator Description

ESRD dialysis starts with a nephrology provider clinician office visit in the window 180 days - 260 days prior to the denominator encounter start date.

Published Fields

• Data Model Keys

  • Encounter ID
  • Primary Plan ID
  • Primary Payor ID
  • Primary Plan Attributee Provider ID
  • Empirical Attributee Individual Nephrology Provider ID
  • Empirical Attributee Nephrology Group Provider ID
  • Empirical Attributee Primary Care Individual Provider ID
  • Empirical Attributee Primary Care Provider Group Provider ID

• Date Fields

  • Encounter Start Date
  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership Episode End Date
  • Current Dialysis Episode Start Date
  • Current Dialysis Episode 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)

• Provider Fields

  • CKD Physician Management Category
  • Count Nephrology Provider Visits in Last 12 Months
  • Empirical Attributee Individual Nephrology Provider Description
  • Empirical Attributee Nephrology Group Provider Description
  • Count Primary Care Visits for CKD in Last 12 Months
  • Primary Care Engagement Category

• Clinical Services Fields

  • Dialysis Modality Category
  • Is Encounter Dialysis Modality Hemodialysis
  • Is Encounter Dialysis Modality Peritoneal Dialysis
  • Is Hospice in Last 12 Months

• Patient Fields

  • Patient Date of Birth
  • Is Patient Alive
  • Patient Age Integer
  • Patient Age Category Tier 1
  • Patient Age Category Tier 2
  • Patient Sex Category
  • Count Hospital Inpatient Admissions in Last 12 Months
  • Count ED Visits Without Inpatient Admissions in Last 12 Months

• Encounter Fields

  • Encounter Setting Category
  • Is Encounter Setting Home
  • Is Encounter Setting Inpatient
  • Is Encounter Setting Outpatient Dialysis Facility
  • Is Encounter Setting Outpatient Non-Dialysis Facility
  • Dialysis Access Type Category
  • Is Dialysis Vascular Access Type Any Catheter
  • Is Dialysis Vascular Access Type Graft Without Catheter
  • Is Dialysis Vascular Access Type Fistula Only

• Location Fields

  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit
  • Patient County Description
  • UW HIP ADI Quintile Category
  • CDC SVI Overall Quintile Category

• Insurance Fields

  • Is Any Current Plan Membership
  • Primary Plan Description

• Diagnosis Fields

  • Count CCW Conditions
  • Is CCW System Behavioral Health
  • Is CCW System Cardiovascular
  • Is CCW System Genitourinary
  • Is CCW System Musculoskeletal
  • Is CCW System Pulmonary
  • Is CCW Diabetes
  • CCW Systems Category
  • Count CCW Systems
  • Is CCW System Congenital
  • Is CCW System Endocrine/Metabolic
  • Is CCW System Hematologic
  • Is CCW System Neurological
  • Is CCW System Oncologic
  • Is CCW System Ophthalmologic
  • Is CCW System Other

• Numerator Fields

  • Nephrologist Office Visit Encounter ID
  • Nephrologist Office Visit Facility Provider ID
  • Nephrologist Office Visit Service Provider ID
  • Nephrologist Office Visit Provider Group ID
  • Nephrologist Office Visit Encounter Date
  • Nephrologist Office Visit Service Provider Description
  • Nephrologist Office Visit Provider Group Description
  • Nephrologist Office Visit Principal Discharge Diagnosis ICD-10-CM Code
  • Nephrologist Office Visit Principal Discharge Diagnosis ICD-10-CM Description
  • Nephrologist Office Visit Primary Plan Allowed Amount
  • Nephrologist Office Visit Primary Plan Paid Amount
  • Nephrologist Office Visit Total Plan Paid Amount from All Plans
  • Nephrologist Office Visit Patient Paid Amount

• Measure Fields

  • Denominator
  • Numerator

• Module Fields

  • CKD Stage Category
  • Is CKD Stage 1
  • Is CKD Stage 2
  • Is CKD Stage 3
  • Is CKD Stage 4
  • Is CKD Stage 5
  • Is ESRD
  • Is CKD Stage Unknown
  • Is CKD Stage 3 or Higher
  • Is CKD Stage 4 or Higher
  • Is Chronic Dialysis Patient
  • Is History of Kidney Transplantation
  • Is CCW CKD