URSA-PHF-022: ED Visits per 1000 Member-Years

Measure Description

Among active membership periods, the rate of emergency department visits without inpatient admission per 1000 member-years.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Interval
• Component Class: Long-Form
• Denominator Case Field: Patient ID
• Target Direction: Down

Denominator Description

The elapsed patient-months among active membership periods during which the patient was alive and had medical claims data coverage.

Numerator Description

The count of emergency department visits without admission to inpatient occurring during qualifying denominator membership periods.

Published Fields

• Data Model Keys

  • Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

  • 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
  • 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

  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership 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)
  • Segmented Period Start Date
  • Segmented Period End Date

• Provider Fields

  • Primary Plan Attributee Provider Description
  • Empirical Attributee Primary Care Individual Provider Description
  • Empirical Attributee Primary Care Provider Group Provider Description

• 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

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Diagnosis Fields

  • 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

• Numerator Fields

  • Encounter ID
  • Encounter Start Date
  • Encounter End Date
  • Encounter LOS in Elapsed Midnights
  • Encounter LOS in Distinct Calendar Days
  • Is Patient Admitted to Observation
  • Facility Provider Description
  • Facility Provider Primary NUCC Provider Taxonomy Code
  • Facility Provider Primary NUCC Provider Taxonomy Description
  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • CMS Admit Source Code
  • CMS Admit Source Description
  • CMS Admit Type Code
  • CMS Admit Type Description
  • CMS Patient Discharge Status Code
  • CMS Patient Discharge Status Description
  • Primary Plan Allowed Amount
  • Primary Plan Paid Amount
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount

• Measure Fields

  • Denominator
  • Numerator

• [No Field Group]

  • Ursa Serial ID