URSA-PHU-008: Percent Potentially Preventable ED and IP Admits

  • Published on Apr 10, 2026
  • 4 minute(s) read
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Measure Description

Among all emergency department visits and inpatient admissions, the percent that are potentially preventable.

Metadata

  • Measure Identifier: URSA-PHU-008
  • Measure Type: Rate Measure
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Denominator Case Field: Encounter ID
  • Target Direction: Down

Denominator Description

One per hospital inpatient admission or emergency department visits.

Numerator Description

Hospital inpatient admissions or emergency department visits that meet the criteria for potentially preventable encounter.

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)
    • 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)
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)

  • Date Fields

    • Encounter Start Date
    • Encounter End Date
    • Encounter LOS in Elapsed Midnights
    • Encounter LOS in Distinct Calendar Days
    • Is Multi-Day Encounter
    • 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)

  • Encounter Fields

    • Is Emergency Department Visit without IP Admit
    • Ursa Encounter Type Tier 1 Category
    • Ursa Encounter Type Tier 2 Category
    • Is Surgery Encounter -- Indicates an encounter in which the patient underwent surgery; identified by the presence, among the documents associated with an encounter, of a surgical HCPCS code or a revenue center code for operating room setting care.
    • Ursa Surgery Encounter Type Category

  • Clinical Services Fields

    • Primary HCPCS Procedure HCPCS Code
    • Primary HCPCS Procedure Short Description
    • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Code
    • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Description

  • Diagnosis Fields

    • Principal Discharge Diagnosis ICD-10-CM Code
    • Principal Discharge Diagnosis ICD-10-CM Description
    • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description

  • Billing and Claims Fields

    • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
    • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
    • MS-DRG MDC Code -- The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Description)
    • MS-DRG MDC Description -- The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Code)
    • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.
    • CMS Patient Discharge Status Description -- The natural language description of a standard CMS Patient Discharge Status code. (See also [URSA-CORE] CMS Patient Discharge Status Code)

  • Financial Fields

    • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
    • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
    • Total Plan Paid Amount from All Plans
    • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

  • Numerator Fields

    • Is PPHE Encounter
    • PPHE Category
    • Is ACS Hospital Inpatient Admission
    • Is Hospital Inpatient Admission with Prior Related Encounter
    • Is High Probability Preventable ED Visit with Inpatient Admission
    • Is High Probability Preventable ED Visit without Inpatient Admission
    • ACS Admission PQI Category
    • 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.
    • Preventable ED Visit Scenario Category

  • Measure Fields

    • Denominator