Ursa Health Preventable Hospital Utilization Module Terms

Is ED High-Utilizer

Indicates that the patient meets at least one of the following criteria: (1) 3 or emergency department visits in the last 3 months; or (2) 6 or more emergency department visits in the last 6 months.

Linked Terms: Is New ED High-Utilizer

Is High Probability Avoidable ED Visit

Identifies a diagnosis code that, when documented on an ED visit, indicates with high probability that the ED visit was avoidable; either because the patient's condition was preventable or because the patient could have been treated in a lower-intensity setting.

Is High Probability Inappropriate for ED Setting

Identifies a diagnosis code that, when documented on an ED visit, indicates with high probability that the patient could have been treated in a lower-intensity setting.

Is New ED High-Utilizer

Indicates that the patient is only recently qualified as a ED High-Utilizer; defined as meeting both of the following criteria: (1) the patient meets the definition of an ED High Utilizer; and (2) all the patient's emergency room visits in the last 12 months have occurred within the last 3 months.

Linked Terms: Is ED High-Utilizer

PPHE

A potentially preventable hospital encounter; defined as any of the following: (1) an ambulatory care sensitive hospital inpatient admission; (2) a hospital inpatient admission with a prior related encounter; or (3) a high-probability avoidable ED visit.

Prior Encounter Scenario Category

A hospital inpatient admission with one or more of the following: (1) prior ED visit within 7 days prior to admission; (2) prior hospital inpatient admission with discharge date within 7 days prior to admission or within 30 days prior to admission and with similar principal discharge diagnoses; or (3) prior SNF stay with discharge date within 14 days prior to admission.