URSA-CKD-109: VS or IR Visit 24 Months to Dialysis

Measure Description

Among instances of ESRD dialysis starts, the percentage with a vascular surgeon or interventional radiologist provider clinician office visit within 24 months prior to start

Metadata

Measure Identifier: URSA-CKD-109
Measure Type: Rate Measure
Temporal Structure: Event
Component Class: Normal-Form
Case Field: Encounter ID
Observation Field: Encounter ID
Target Direction: Up

Denominator Description

One record per ESRD Start Encounter with dialysis. The encounter marks the progression of a CKD patient from stage 5 or below to ESRD. In all cases, the patient must be found to meet the criteria for ESRD as of the dialysis encounter, and only the first qualifying encounter in the patient’s life is included.

Numerator Description

ESRD dialysis starts with a vascular surgeon or interventional radiologist provider clinician office visit in the window 24 months prior to the denominator encounter start date.

Published Fields

Data Model Keys
- Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
- Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
- 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 Attributee Provider ID
- Empirical Attributee Individual Nephrology Provider ID
- Empirical Attributee Nephrology Group Provider ID
- Empirical Attributee Primary Care Individual Provider ID
- Empirical Attributee Primary Care Provider Group Provider ID
Date Fields
- Encounter Start Date
- Current Continuous Primary Payor Membership Episode Start Date -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode)
- Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period End Date)
- Current Dialysis Episode Start Date
- Current Dialysis 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)
Provider Fields
- CKD Physician Management Category
- Count Nephrology Provider Visits in Last 12 Months
- Empirical Attributee Individual Nephrology Provider Description
- Empirical Attributee Nephrology Group Provider Description
- Count Primary Care Visits for CKD in Last 12 Months
- Primary Care Engagement Category
Clinical Services Fields
- Dialysis Modality Category
- Is Encounter Dialysis Modality Hemodialysis
- Is Encounter Dialysis Modality Peritoneal Dialysis
- Is Hospice in Last 12 Months -- Evidence of CMS hospice status or evidence of hospice services in the last 12 months. Typically used as a denominator exclusion.
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.
- Is Patient Alive
- 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
Encounter Fields
- Encounter Setting Category
- Is Encounter Setting Home
- Is Encounter Setting Inpatient
- Is Encounter Setting Outpatient Dialysis Facility
- Is Encounter Setting Outpatient Non-Dialysis Facility
- Dialysis Access Type Category
- Is Dialysis Vascular Access Type Any Catheter
- Is Dialysis Vascular Access Type Graft Without Catheter
- Is Dialysis Vascular Access Type Fistula Only
Location Fields
- Patient State Abbreviation
- Patient ZIP Code 5-Digit
- Patient County Description
- 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)
- CDC SVI Overall Quintile Category -- The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. 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.
Insurance Fields
- Is Any Current Plan Membership
- Primary Plan Description
Diagnosis Fields
- 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 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 Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD).
- 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 Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis.
- 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.
- 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 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 Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
- 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 Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.
Numerator Fields
- VS or IR Office Visit Encounter ID
- VS or IR Facility Provider ID
- VS or IR Service Provider ID
- VS or IR Provider Group Provider ID
- VS or IR Encounter Date
- VS or IR Service Provider Description
- VS or IR Provider Group Description
- VS or IR Principal Discharge Diagnosis ICD-10-CM Code
- VS or IR Principal Discharge Diagnosis ICD-10-CM Description
- VS or IR Primary Plan Allowed Amount
- VS or IR Primary Plan Paid Amount
- VS or IR Total Plan Paid Amount from All Plans
- VS or IR Patient Paid Amount
Measure Fields
- Denominator
- Numerator
Module Fields
- CKD Stage Category -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate.

The following eGFR bands are used:

GFR >= 90: Stage 1;
60 <= GFR < 90: Stage 2;
30 <= GFR < 60: Stage 3;
15 <= GFR < 30: Stage 4;
GFR < 15: Stage 5.