URSA-QUALITY-FUM7: Follow Up to ED Visit for Mental Illness (FUM7)

Measure Description

The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness, or any diagnosis of intentional self-harm, and had a mental health follow-up service.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Entity
• Component Class: Long-Form
• Denominator Case Field: Output NCQA Payer Type Code, Parent Document ID, Patient ID
• Target Direction: Up

Denominator Description

ED Visits for patients 18 and older

Numerator Description

Qualifying denominator patients with a Follow Up Visit within 7 Days

Published Fields

• [No Field Group]

  • Measure ID
  • Measure Name
  • Ursa Serial ID

• Data Model Keys

  • Patient ID
  • Primary Plan Attributee Provider ID
  • Primary Payor ID
  • Primary Plan ID

• Date Fields

  • Index ED Parent Document Effective Start Date
  • Index ED Parent Document Effective End Date
  • Current Continuous Primary Payor Membership Episode Start Date
  • Current Continuous Primary Payor Membership 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)
  • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

• Patient Fields

  • Patient Age Integer at Index ED Visit
  • Patient Operational ID
  • Patient Date of Birth
  • Is Patient Sex Female
  • Is Patient Sex Male
  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Denominator Fields

  • Is Continuous Membership Criterion Met
  • Is Eligible Population
  • Is Any Required Exclusion
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Patient Death
  • Is Denominator Event Criteria Met
  • Denominator Excluded Reasons Description
  • Index ED Claim ID
  • Denominator Performance Period End Date
  • Denominator Performance Period Start Date
  • ED Parent Document Effective End Date + 30 Days

• Numerator Fields

  • Is Numerator Qualifying Using Standard End-of-Year Timing
  • Numerator Component Contribution Using Standard End-of-Year Timing
  • Numerator Document ID
  • Numerator Source ID
  • Numerator Document Effective Date
  • Numerator HCPCS Code
  • Numerator HCPCS Description
  • Numerator Document Type Description

• NCQA Cert Fields

  • Is NCQA Numerator Criteria Met
  • Output NCQA Payer Type Code
  • Patient Age Integer Unbounded at Index ED Visit
  • NCQA Race Code
  • NCQA Ethnicity Code

• Provider Fields

  • Primary Plan Attributee Provider Description

• Metadata Fields

  • Table Last Updated Datetime
  • Is Parameter Set to Override Continuous Enrollment Criteria
  • Is Parameter Set to Override Payor Criteria

• Measure Fields

  • Denominator
  • Numerator