[SO/URSA-QUALITY] PCR Measure IHS Episodes

Object Description

One row per IHS episode - NCQA payer pairs with exclusion criteria flagged (but not applied) except for the "outlier" exclusion (which requires knowledge of the measure snapshot date to calculate), and with first admission and last discharge dates calculated, including for episodes with one or more direct transfers.

Metadata

• Table Name: ursa.so_ursa_quality_enc_007
• Layer: SYNTHETIC_OBJECT
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Record ID
• Event Date:
• Primary Key: Record ID

Published Fields

• Data Model Keys

  • Record 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)
  • Episode Last Encounter Master Document ID
  • IHS Episode ID

• Patient Fields

  • Is Aged 65+
  • Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval.
  • Is Patient Sex Female -- Indicates the patient's sex is female. 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 patient sex documented on that particular type of record in the source data.
  • Is Patient Sex Male -- Indicates the patient's sex is male. 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 patient sex documented on that particular type of record in the source data.

• Date Fields

  • IHS Episode First Encounter Admission Date
  • IHS Episode Last Encounter Discharge Date

• Diagnosis Fields

  • IHS Episode Last Encounter Principal Discharge Diagnosis ICD-10-CM Code

• Metadata Fields

  • Observation Stay Standard PCR Variable Weight
  • Surgery Standard PCR Variable Weight
  • Discharge Condition 1 CC Code
  • Discharge Condition 1 Standard PCR Variable Weight
  • Discharge Condition 2 CC Code
  • Discharge Condition 2 Standard PCR Variable Weight
  • Discharge Condition 3 CC Code
  • Discharge Condition 3 Standard PCR Variable Weight
  • COVID Standard PCR Variable Weight
  • Comorbidities Standard PCR Variable Weight
  • Patient Demographics Standard PCR Variable Weight
  • Observation Stay SNF PCR Variable Weight
  • Surgery SNF PCR Variable Weight
  • Discharge Condition 1 SNF PCR Variable Weight
  • Discharge Condition 2 SNF PCR Variable Weight
  • Discharge Condition 3 SNF PCR Variable Weight
  • COVID SNF PCR Variable Weight
  • Comorbidities SNF PCR Variable Weight
  • Patient Demographics SNF PCR Variable Weight
  • Payor Parent Type Code
  • NCQA PCR Reporting Indicator Code
  • Is Any Commercial Output NCQA Payer Type Code
  • Is Any Medicare Output NCQA Payer Type Code
  • Is Any Medicaid Output NCQA Payer Type Code
  • Is Any Exchange Output NCQA Payer Type Code
  • Is Any SNP Output NCQA Payer Type Code
  • Is Any MMP Output NCQA Payer Type Code

• Validation Only Fields

  • Is Episode Last Encounter with Observation Stay
  • Is Surgery Episode

• Module Fields

  • Is Single-Day Episode
  • Is SNF Admission After Episode Discharge
  • Is Exclusion for Principal Diagnosis Pregnancy
  • Is Exclusion for Principal Diagnosis Perinatal Conditions
  • Is Exclusion for Principal Diagnosis Chemotherapy
  • Is Exclusion for Patient Death
  • Is Exclusion for Principal Diagnosis Rehabilitation
  • Is Exclusion for Kidney Transplant
  • Is Exclusion for Bone Marrow Transplant
  • Is Exclusion for Organ Transplant Other Than Kidney
  • Is Exclusion for Introduction of Autologous Pancreatic Cells
  • Is Exclusion for Potentially Planned Procedures Without Acute Condition
  • Output NCQA Payer Type Code
  • Is Commercial Output NCQA Payer Type Code
  • Is Medicare Output NCQA Payer Type Code
  • Is Medicaid Output NCQA Payer Type Code
  • Is Exchange Output NCQA Payer Type Code
  • Is SNP Output NCQA Payer Type Code
  • Is MMP Output NCQA Payer Type Code

Dedicated Precursors

• [SO/URSA-QUALITY] PCR Measure IHS Episodes, Precursor 1 (Index Hospital Stay Master Documents): One row per master document (claim header, bill header, or EMR encounter document) meeting the initial ("Step 1") criteria as an "index hospital stay" (IHS) for the Plan All-Cause Readmission (PCR) measure. Includes an Episode ID for grouping sequences of IHS encounters meeting the "direct transfer" criteria. Does not apply exclusions described in Steps 2 - 6, e.g., pregnancy or perinatal conditions, patient death, "outliers", etc.
• [SO/URSA-QUALITY] PCR Measure IHS Episodes, Precursor 2 (IHS Episode - NCQA Payer Pairs Without Risk Adjustment): One row per IHS episode - NCQA payer pairs with exclusion criteria flagged (but not applied) except for the "outlier" exclusion (which requires knowledge of the measure snapshot date to calculate), and with first admission and last discharge dates calculated, including for episodes with one or more direct transfers.
• [SO/URSA-QUALITY] PCR Measure IHS Episodes, Precursor 3 (Comorbid Conditions): One record per IHS Episode - NCQA HCC code, representing the comorbid conditions associated with the IHS episode.
• [SO/URSA-QUALITY] PCR Measure IHS Episodes, Precursor 4 (Long-Form Episode Risk Weights): One record per episode - risk variable code pair, with the numeric weight. Following the convention of the NCQA certification key, the standard (non-SNF) weights are reported for every case, and SNF weights are additionally reported for IHS episodes with a discharge to SNF.