Measure Description
One record for each encounter during which the patient underwent dialysis one or more times, for which the patient was considered to have CKD as of the end of the encounter start date.
Metadata
- Measure Identifier: URSA-CKD-R02
- Measure Type: Registry
- Temporal Structure: Event
- Component Class: Normal-Form
- Case Field: Encounter ID
- Observation Field: Encounter ID
- Target Direction: None
Published Fields
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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)
- 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)
- Encounter Facility 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
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Patient Fields
- 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
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Date Fields
- Encounter Start Date
- 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)
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Encounter Fields
- Encounter Setting Category
- Is Encounter Setting Home or Outpatient Dialysis Facility
- Is Encounter Setting Home
- Is Encounter Setting Outpatient Dialysis Facility
- Is Encounter Setting Inpatient
- Is Encounter Setting Outpatient Non-Dialysis Facility
- Encounter Qualifying Document HCPCS Code
- Encounter Qualifying Document CMS Revenue Center Code
- Encounter CMS Type of Bill Code
- Encounter CMS Place of Service Code
- Is Hospital Inpatient Admission Encounter
- Is Emergency Department Visit Parent Encounter -- Value of "1" if true that the hospital inpatient admission is connected to a Department Visit Parent Encounter during which the patient received care in an emergency room setting; operationally defined by the presence of one or more of the following: (1) a qualifying revenue center code value on an institutional claim or bill; (2) a qualifying HCPCS code on an institutional claim or bill; or (3) an EMR encounter record flagged as an ED visit (i.e., Is Encounter Type ED Visit = 1). Encounters can be nested; that is, one “parent” encounter can contain one or more “child” encounters.
- Is Observation Stay Parent Encounter -- Indicates the patient received care in a hospital observation setting. In the context of Hospital Inpatient Admission Encounters, this field will identify IP Admits that came from an observation stay as a part of the Hospital Inpatient Admission Encounter (True = "1"). (See also [URSA-CORE] Encounter)
- Is Encounter Outpatient Dialysis at Non-Dialysis Facility Setting
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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 Visits with Attributee Individual Primary Care Provider in Last 36 Months
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Location Fields
- 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)
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Insurance Fields
- Primary Plan Description
- Primary Plan Financial Class Description
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Clinical Services Fields
- Dialysis Modality Category
- Is Dialysis Modality Hemodialysis
- Is Dialysis Modality Peritoneal Dialysis
- Vascular Access Type Category
- Is Vascular Access Type Any Catheter
- Is Vascular Access Type Graft Without Catheter
- Is Vascular Access Type Fistula Only
- 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.
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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 Alzheimers 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 3 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 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 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.
- CCW Count Category
- 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.
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Measure Fields
- Denominator
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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.
The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter)
- Is ESRD -- 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.
The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter)
- Is CKD Stage Unknown
- Is CKD Stage 3 or Higher
- Is CKD Stage 4 or Higher
- Is Chronic Dialysis Patient -- Indicates that the patient has either (1) documentation in the last 12 months of a chronic dialysis status code; or (2) is currently undergoing regular episode as part of an episode that contains at least one non-inpatient dialysis encounter.