ACS Admission PQI Category
A categorical field identifying which specific AHRQ Prevention Quality Indicator (PQI) criterion the ambulatory care sensitive (ACS) admission meets. Values are:
[01] PQI 01 Diabetes Short-Term Complications
[02] PQI 02 Perforated Appendix
[03] PQI 03 Diabetes Long-Term Complications
[04] PQI 05 Older Adult COPD or Asthma
[05] PQI 07 Hypertension
[06] PQI 08 Heart Failure
[07] PQI 09 Low Birth Weight
[08] PQI 10 Dehydration
[09] PQI 11 Bacterial Pneumonia
[10] PQI 12 Urinary Tract Infection
[11] PQI 14 Uncontrolled Diabetes
[12] PQI 15 Younger Adult Asthma
[13] PQI 16 Diabetic Lower-Extremity Amputation
[97] Multiple PQI Criteria Met
This field is NULL for encounters that are not ACS admissions (i.e., where is_acs_hospital_inpat_admission = 0). Each PQI is determined by AHRQ-specified principal diagnosis value sets, age thresholds, and exclusion criteria (transfer admits, cardiac procedures, immunocompromised state, condition-specific exclusion diagnoses).
Is ACS Hospital Inpatient Admission
A hospital inpatient admission that meets the numerator criteria for one or more AHRQ Prevention Quality Indicators (PQIs 01, 02, 03, 05, 07, 08, 09, 10, 11, 12, 14, 15, 16). These are conditions for which high-quality outpatient care can potentially prevent hospitalization or for which early intervention can prevent complications or more severe disease. Qualification is determined by the principal discharge diagnosis matching an AHRQ PQI numerator value set, subject to age eligibility, non-newborn transfer-admit source exclusion, and PQI-specific procedure and diagnosis exclusions (e.g., cardiac procedures, immunocompromised state, kidney disease with dialysis access). Also known as an Ambulatory Care Sensitive (ACS) admission.
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 High Probability Preventable ED Visit with Inpatient Admission
A binary indicator (1/0) identifying an ED visit that is classified as high-probability preventable AND that resulted in the patient being admitted to hospital inpatient status. An ED visit is deemed "high probability preventable" when any of the following conditions are met (based on NYU Emergency Department Algorithm [NYUEDA] classification of the principal discharge diagnosis):
[01] The principal diagnosis has a ≥67% pooled probability of being preventable (due to inappropriate setting and/or preventable condition), AND the visit did not involve a high-intensity E&M service (which would suggest clinical complexity warranting ED care); OR
[02] The principal diagnosis has a ≥67% probability of representing a preventable condition (regardless of other factors).
These thresholds can be customized per client request. In this data mart, the encounter grain is the parent hospital inpatient admission encounter that contains the ED visit.
Is High Probability Preventable ED Visit without Inpatient Admission
A binary indicator (1/0) identifying an ED visit that is classified as high-probability preventable AND that did NOT result in the patient being admitted to hospital inpatient status. The same preventability logic applies as described for "Is High Probability Preventable ED Visit with Inpatient Admission" (≥67% NYUEDA-based probability threshold which can be customized per client request, with high-intensity E&M exclusion for the inappropriate-setting pathway). These encounters represent ED utilization that may have been avoidable through timely ambulatory care, urgent care access, or chronic disease management.
Is Hospital Inpatient Admission with Prior Related Encounter
A binary indicator (1/0) identifying a hospital inpatient admission that was preceded by one or more related healthcare encounters within defined lookback windows. Specifically, the admission must have at least one of the following:
[01] A prior ED visit (that did not itself result in an inpatient admission) within 2–7 days prior to the admission date, provided no intervening admission or SNF stay occurred between the ED visit and the index admission.
[02] A prior hospital inpatient admission with a discharge date either (a) within 7 days prior to the index admission, or (b) within 30 days prior with a matching principal discharge diagnosis (at the AHRQ CCS single-level category). Prior admissions with a CMS discharge status code on the "Index Admission Exclusions for Readmission Measure" value set are excluded from consideration.
[03] A prior SNF stay with a discharge date within 14 days prior to the index admission, provided no intervening admission occurred between the SNF discharge and the index admission.
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.
PPHE Category
A categorical classification of the type of potentially preventable hospital encounter (PPHE). Each encounter is assigned to one of the following mutually exclusive categories based on which preventability criteria it meets:
[01] ACS Hospital Inpatient Admission – The admission meets one or more AHRQ Prevention Quality Indicator (PQI) criteria (ambulatory care sensitive condition).
[02] Hospital Inpatient Admission with Prior Related Encounter – The admission was preceded by a related encounter (prior ED visit, prior admission, or prior SNF stay) within defined lookback windows.
[03] High Probability Preventable ED Visit with Inpatient Admission – An ED visit classified as high-probability preventable that also resulted in an inpatient admission.
[04] High Probability Preventable ED Visit without Inpatient Admission – An ED visit classified as high-probability preventable that did not result in an inpatient admission.
[05] Multiple Preventable Criteria Met – The encounter qualifies under more than one of the above criteria simultaneously.
[99] Unclassifiable or Missing Data – The encounter could not be classified due to missing or ambiguous data.
Preventable ED Visit Scenario Category
A categorical field classifying the reason an ED visit is considered high-probability preventable, based on NYU Emergency Department Algorithm (NYUEDA) diagnosis-level probabilities. Values are:
[01] High Probability of Preventable ED Visit Due to Inappropriate Setting Only – The principal diagnosis has a ≥67% probability of representing an inappropriate use of the ED setting (i.e., the condition could have been treated in a lower-acuity setting), but does NOT independently meet the preventable condition threshold. The visit also did not involve a high-intensity E&M service.
[02] High Probability of Preventable ED Visit Due to Preventable Condition Only – The principal diagnosis has a ≥67% probability of representing a preventable condition (i.e., the condition itself could have been prevented with adequate ambulatory care), regardless of setting appropriateness or E&M intensity.
[03] High Probability of Preventable ED Visit Due to Pooled Probability of Inappropriate Setting and/or Preventable Condition – The principal diagnosis meets the ≥67% threshold on the combined/pooled preventability probability (inappropriate setting + preventable condition), and the visit did not involve a high-intensity E&M service, but does not independently meet either the setting-only or condition-only threshold at ≥67%.
[04] Not High Probability of Preventable ED Visit – The diagnosis was classifiable via NYUEDA but did not meet any ≥67% preventability threshold.
[99] Unclassifiable or Missing Data – The principal diagnosis could not be matched to the NYUEDA reference table.
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.