URSA-PHU-008: Percent Potentially Preventable ED and IP Admits

Measure Description

Among all emergency department visits and inpatient admissions, the percent that are potentially preventable.

Metadata

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

Denominator Description

One per hospital inpatient admission or emergency department visits.

Numerator Description

Hospital inpatient admissions or emergency department visits that meet the criteria for potentially preventable encounter.

Published Fields

• Data Model Keys

  • Encounter ID
  • Patient ID
  • Facility Provider ID

• Date Fields

  • Encounter Start Date
  • Encounter End Date
  • Encounter LOS in Elapsed Midnights
  • Encounter LOS in Distinct Calendar Days
  • Is Multi-Day Encounter
  • 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

  • Is Emergency Department Visit without IP Admit
  • Ursa Encounter Type Tier 1 Category
  • Ursa Encounter Type Tier 2 Category
  • Is Surgery Encounter
  • Ursa Surgery Encounter Type Category

• Clinical Services Fields

  • Primary HCPCS Procedure HCPCS Code
  • Primary HCPCS Procedure Short Description
  • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Code
  • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Description

• Diagnosis Fields

  • 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

• Billing and Claims Fields

  • MS-DRG Code
  • MS-DRG Description
  • MS-DRG MDC Code
  • MS-DRG MDC Code Description
  • CMS Patient Discharge Status Code
  • CMS Patient Discharge Status Description

• Financial Fields

  • Primary Plan Allowed Amount
  • Primary Plan Paid Amount
  • Total Plan Paid Amount from All Plans
  • Patient Paid Amount

• Numerator Fields

  • Is PPHE Encounter
  • 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
  • Preventable ED Visit Scenario Category

• Measure Fields

  • Denominator
  • Numerator