URSA-QUALITY-LBP: Use of Imaging Studies for Low Back Pain (LBP)

Measure Description

Among qualifying patients aged 18 to 75 with a new diagnosis of low back pain in the prior 12 months, the percentage without a qualifying imaging study within 28 days of the index diagnosis.

Metadata

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

Denominator Description

Patients aged 18 to 75 with a new diagnosis of low back pain in the prior 12 months.

Numerator Description

Qualifying denominator patients without a qualifying imaging study within 28 days following the index low back pain diagnosis.

Published Fields

• Data Model Keys

  • Measure ID
  • Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

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

• Date Fields

  • Current Continuous Primary Payor Membership Episode End Date
  • Current Continuous Primary Payor Membership Episode Start 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.

• Provider Fields

  • Primary Plan Attributee Provider ID
  • Primary Plan Attributee Provider Description
  • Primary Plan Attributee Primary NUCC Provider Taxonomy Description

• Insurance Fields

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

• Denominator Fields

  • Is Denominator Event/Diagnosis Criterion Met
  • Index Episode Document ID
  • Index Episode ICD-10-CM Code
  • Index Episode ICD-10-CM Description
  • Index Episode Start Date
  • Index Episode Document Effective Start Date
  • Index Episode Document Effective End Date
  • Index Episode Parent Document Effective Start Date
  • Resulting Inpatient Stay ICD-10-CM Code
  • Resulting Inpatient Stay ICD-10-CM Description
  • Is Continuous Membership Criterion Met
  • Is Eligible Population
  • Is Any Required Exclusion
  • Is Required Exclusion for Prolonged Corticosteriod Use
  • Is Required Exclusion for Osteoporosis Medication
  • Is Required Exclusion for Palliative Care
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Death
  • Is Required Exclusion for 66+ Frailty and Advanced Illness
  • Is Required Exclusion for Diagnosis History That May Warrant Imaging
  • Is Required Exclusion for Procedure History That May Warrant Imaging
  • Is Required Exclusion for Recent Diagnoses That May Warrant Imaging
  • Is Required Exclusion for Recent Injuries That May Warrant Imaging

• Numerator Fields

  • Numerator Document ID
  • Numerator Source ID
  • Numerator Document Effective Date
  • Numerator HCPCS Code
  • Numerator HCPCS Description
  • Numerator Document Type Description

• Metadata Fields

  • Measure Name
  • Is Inverted Measure
  • Is Parameter Set to Override Continuous Enrollment Criteria
  • Is Parameter Set to Override Payor Criteria

• Measure Fields

  • Denominator
  • Numerator

• NCQA Cert Fields

  • Is NCQA Numerator Criteria Met
  • Output NCQA Payer Type Code
  • NCQA Race Code
  • NCQA Ethnicity Code
  • NCQA Gender Code
  • Patient Age Integer Unbounded by Death

• [No Field Group]

  • Ursa Serial ID