URSA-PHF-037: Observation Discharge 60-Day Return to Inpatient

  • Published on Apr 23, 2026
  • 10 minute(s) read
Prev Next

Measure Description

Among hospital observation stays without admission, the percentage with a hospital inpatient admit within 60 days of discharge

Metadata

  • Measure Identifier: URSA-PHF-037
  • Measure Type: Rate Measure
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Denominator Case Field: Observation Encounter ID
  • Target Direction: Down

Denominator Description

Observation stays where the patient was not admitted to inpatient, transferred, or expired.

Numerator Description

Hospital Inpatient Admissions occurring within 60 days of the discharge from the denominator observation stay

Published Fields

  • Data Model Keys

    • Observation Encounter ID
    • 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)
    • Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor)
    • Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.

  • Date Fields

    • Observation Encounter Start Date
    • Observation 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)

  • Encounter Fields

    • Observation LOS in Elapsed Midnights
    • Is Observation Encounter LOS >= 2 Midnights
    • Ursa Observation Stay Principal Diagnosis Category
    • Is Observation Principal Discharge Diagnosis Chest Pain
    • Is Observation Principal Discharge Diagnosis CHF
    • Is Observation Principal Discharge Diagnosis Asthma
    • Observation Principal Discharge Diagnosis ICD-10-CM Code
    • Observation Principal Discharge Diagnosis ICD-10-CM Description
    • Observation Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Observation Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description

  • Patient Fields

    • Patient Date of Birth -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data.
    • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
    • Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2)
    • Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1)
    • Patient Sex Category
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months
    • Primary Care Engagement Category
    • Specialty Care Engagement Category

  • Location Fields

    • Patient ZIP Code 5-Digit
    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)
    • UW HIP ADI Decile Category

  • Insurance Fields

    • Primary Payor Description
    • Primary Plan Description

  • Diagnosis Fields

    • CCW Count Category
    • Count CCW Conditions -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions)
    • Is CCW Acquired Hypothyroidism -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Acute Myocardial Infarction -- At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Asthma -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Atrial Fibrillation -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW CKD -- Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years.
    • Is CCW COPD and Bronchiectasis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depression -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depressive Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Diabetes -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Heart Failure -- At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Hyperlipidemia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Hypertension -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Ischemic Heart Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW PVD -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Schizophrenia or Other Psychotic Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Stroke or Transient Ischemic Attack -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
      EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
      804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders.
    • Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD).
    • Is CCW System Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
    • Is CCW System Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis.
    • Is CCW System Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.

  • Billing and Claims Fields

    • Observation CMS Patient Discharge Status Code
    • Observation CMS Patient Discharge Status Description

  • Numerator Fields

    • HIA Encounter ID
    • HIA Facility Provider ID
    • HIA Encounter Start Date
    • HIA Encounter End Date
    • Days Elapsed from Index Admission Discharge to Readmission
    • Inpatient Admit Timing Category
    • Is Inpatient Admit to Observation Stay Facility
    • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS Single Level
    • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS T1
    • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS T2
    • HIA Ursa Hospital Admission Condition-Treatment Type Tier 1 Category
    • Inpatient LOS Category Tier 1 -- Classifies the encounter based on the length of stay in elapsed midnights between the encounter inpatient status start date (or encounter start date when inpatient status start date is unavailable) and the encounter end date (patient discharge from inpatient status).
    • Is Inpatient LOS < 2 Midnights
    • Inpatient LOS in Elapsed Midnights
    • Is HIA Emergency Department Visit Parent Encounter
    • Is HIA Observation Stay Parent Encounter
    • Is HIA Discharge Status Home or Home with Home Health
    • HIA Principal Discharge Diagnosis ICD-10-CM Code
    • HIA Principal Discharge Diagnosis ICD-10-CM Description
    • HIA Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • HIA Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
    • HIA Discharge Diagnosis WHO ICD-10 Chapter Description
    • HIA Discharge Diagnosis WHO ICD-10 Block Description
    • HIA Facility Provider Description
    • HIA Facility Provider ZIP Code 5-Digit
    • HIA MS-DRG Code
    • HIA MS-DRG Description
    • HIA MS-DRG MDC Code
    • HIA MS-DRG MDC Description
    • HIA Total Plan Paid Amount from All Plans
    • HIA Calculated MS-DRG Mean Length of Stay in Calendar Days
    • HIA Relative Change of Encounter LOS to Calculated MS-DRG Mean

  • Measure Fields

    • Denominator