Dimensional Warehouse Model Data Model

Entity

Entity HEDIS Utilization Analysis

Description

This Analytical Requirement includes measures developed by the National Committee for Quality Assurance (NCQA) and published as part of the Healthcare Effectiveness Data and Information Set (HEDIS) 2015 Volume 2 specification.

Dimensions (and sample axes of analysis):
- Time Period (Reporting Year)
- Geographic Area (Region, State)
- Plan Member (Plan, Line of Business(Medicare, Medicaid, Commercial))
- Patient (Age range, Gender, Language, Race)
- Encounter (Procedure)
- Analytical Classification (Optional - used for measures (RAS), (RCA), (RCO), (RDI) & (RHY))

Attributes
Adolescent Well-Care Visits (AWC)
Ambulatory Care (AMB)
Analytical Classification Dk
Antibiotic Utilization (ABX)
Average Days Supply Per Antibiotic Prescription (ABX-n)
Average Number Of Antibiotic Prescriptions PMPY (ABX-n)
Average Number Of Prescriptions For Antibiotics Of Concern PMPY (ABX-n)
Calendar Dk
Encounter Dk
Frequency Of Ongoing Prenatal Care (FPC)
Frequency of Selected Procedures (FSP)
Geographic Area Dk
Identification Of Alcohol And Other Drug Services (IAD)
Inpatient Utilization-General Hospital/Acute Care (IPU)
Mental Health Utilization (MPT)
Number Of 30 Day Readmissions (PCR-n)
Number Of Abdominal Hysterectomy Procedures Performed (FSP-n)
Number Of Acute Inpatient Days (IPU-n)
Number Of Acute Inpatient Discharges (IPU-n)
Number Of Acute Maternity Inpatient Days (IPU-n)
Number Of Acute Maternity Inpatient Discharges (IPU-n)
Number Of Acute Medical Inpatient Days (IPU-n)
Number Of Acute Medical Inpatient Discharges (IPU-n)
Number Of Acute Patient Stays (PCR-d)
Number Of Acute Surgical Inpatient Days (IPU-n)
Number Of Acute Surgical Inpatient Discharges (IPU-n)
Number Of Adolescents (AWC-d)
Number Of Adolescents With Well-Care Visits (AWC-n)
Number Of Antibiotic Prescriptions (ABX-n)
Number Of AOD Members (IAD-d)
Number Of AOD Members Receiving Chemical Dependency Services (IAD-n)
Number Of Back Surgery Procedures Performed (FSP-n)
Number Of Bariatric Weight Loss Surgery Procedures Performed (FSP-n)
Number Of Cardiac Catheterization Procedures Performed (FSP-n)
Number Of Carotid Endarterectomy Procedures Performed (FSP-n)
Number Of Children 3-6 Years Old (W34-d)
Number Of Children 3-6 Years Old With PCP Well-Child Visit (W34-n)
Number Of Coronary Artery Bypass Graft (CABG) Procedures Performed (FSP-n)
Number Of Days Supply For All Antibiotic Prescriptions (ABX-n)
Number Of Deliveries Of Live Births (FPC-d)
Number Of ED Visits (AMB-n)
Number Of Laparoscopic Cholecystectomy Procedures Performed (FSP-n)
Number Of Live Births With Expected Prenatal Visits (FPC-n)
Number Of Lumpectomy Procedures Performed (FSP-n)
Number Of Mastectomy Procedures Performed (FSP-n)
Number Of Member Months (AMB-d)
Number Of Member Months (FSP-d)
Number Of Member Months (IPU-d)
Number Of Members (MPT-d)
Number Of Members 15 Months Old (W15-d)
Number Of Members Receiving Mental Health Services (MPT-n)
Number Of Members With Well-Child Visits In The First 15 Months Of Life (W15-n)
Number Of Member Years (ABX-d)
Number Of Member Years (AMB-d)
Number Of Member Years (FSP-d)
Number Of Member Years (IPU-d)
Number Of Open Cholecystectomy Procedures Performed (FSP-n)
Number Of Outpatient Visits (AMB-n)
Number Of Percutaneous Coronary Intervention (PCI) Procedures Performed (FSP-n)
Number Of Prescriptions For Antibiotics Of Concern (ABX-n)
Number Of Procedures Performed (FSP-n)
Number Of Prostatectomy Procedures Performed (FSP-n)
Number Of Tonsillectomy Procedures Performed (FSP-n)
Number Of Total Hip Replacement Procedures Performed (FSP-n)
Number Of Total Knee Replacement Procedures Performed (FSP-n)
Number Of Vaginal Hysterectomy Procedures Performed (FSP-n)
Patient Dk
Percentage Of Antibiotics Of Concern For All Antibiotic Prescriptions (ABX-n)
Plan All-Cause Readmissions (PCR)
Plan Member Dk
Well-Child Visits In The First 15 Months Of Life (W15)
Well-Child Visits In The Third Fourth Fifth And Sixth Years Of Life (W34)

Relationship
HEDIS Utilization Analysis_Calendar Dimension_FK
HEDIS Utilization Analysis_Geographic Area Dimension_FK
HEDIS Utilization Analysis_Plan Member Dimension_FK
HEDIS Utilization Analysis_Patient Dimension_FK
HEDIS Utilization Analysis_Encounter Dimension_FK
HEDIS Utilization Analysis_Analytical Classification_FK

Primary Key
HEDIS Utilization Analysis PK

Dependencies
NONE

Reverse Dependencies

Attribute Details

Adolescent Well-Care Visits (AWC)

Description	The percentage of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Ambulatory Care (AMB)

Description	This measure summarizes utilization of ambulatory care in the following categories: - Outpatient Visits. - ED Visits. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Note that the measure reports a count of visits as well as ratios expressed as Number of visits per 1000 member months and / or number of visits per 1000 member years. Formula: [A or ((A/C) 1000) or ((A/D) 1000) or B or ((B/C) 1000) or ((B/D) 1000)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Analytical Classification Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Antibiotic Utilization (ABX)

Description	This measure summarizes the following data on outpatient utilization of antibiotic prescriptions during the measurement year, stratified by age and gender: - Total number of antibiotic prescriptions. - Average number of antibiotic prescriptions per member per year (PMPY). - Total days supplied for all antibiotic prescriptions. - Average days supplied per antibiotic prescription. - Total number of prescriptions for antibiotics of concern. - Average number of prescriptions PMPY for antibiotics of concern. - Percentage of antibiotics of concern for all antibiotic prescriptions. - Average number of antibiotics PMPY reported by drug class: - For selected "antibiotics of concern." - For all other antibiotics. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [A or B or C or D or E or F or G] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Average Days Supply Per Antibiotic Prescription (ABX-n)

Description	The average number of days supply of all antibiotics per antibiotic prescription. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Average Number Of Antibiotic Prescriptions PMPY (ABX-n)

Description	The average number of outpatient antibiotic prescriptions per member per year (PMPY) during the measurement year. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Average Number Of Prescriptions For Antibiotics Of Concern PMPY (ABX-n)

Description	The average number of outpatient prescriptions for antibiotics of concern per member per year (PMPY) during the measurement year. Formula: [A/B] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Calendar Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Encounter Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Frequency Of Ongoing Prenatal Care (FPC)

Description	The percentage of Medicaid deliveries between November 6 of the year prior to the measurement year and November 5 of the measurement year that had the following number of expected prenatal visits: 21 percent of expected visits. 21 percent-40 percent of expected visits. 41 percent-60 percent of expected visits. 61 percent-80 percent of expected visits. =81 percent of expected visits. This measure uses the same denominator as the Prenatal and Postpartum Care measure. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Frequency of Selected Procedures (FSP)

Description	This measure summarizes the utilization of frequently performed procedures that often show wide regional variation and have generated concern regarding potentially inappropriate utilization. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Note that the measure reports a count of the various procedures performed as well as ratios expressed as Number of procedures per 1000 member months and / or number of procedures per 1000 member years. Formula: [A or ((A/B) 1000) or ((A/C) 1000)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Geographic Area Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Identification Of Alcohol And Other Drug Services (IAD)

Description	This measure summarizes the number and percentage of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: - Any service. - Inpatient. - Intensive outpatient or partial hospitalization. - Outpatient or ED. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Inpatient Utilization-General Hospital/Acute Care (IPU)

Description	This measure summarizes utilization of acute inpatient care and services in the following categories: - Total inpatient. - Medicine. - Surgery. - Maternity. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Note that the measure reports a count of visits as well as ratios expressed as Number of visits per 1000 member months and / or number of visits per 1000 member years. Formula: [A or B or C or D or E or F or G or H or (B/A) or (D/C) or(F/E) or (H/G) or (((A or B or C or D or E or F or G or H) / (I or J)) *1000)] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Mental Health Utilization (MPT)

Description	The number and percentage of members receiving the following mental health services during the measurement year: - Any service. - Inpatient. - Intensive outpatient or partial hospitalization. - Outpatient or ED. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of 30 Day Readmissions (PCR-n)

Description	The number of acute inpatient stays with a discharge on or between January 1 and December 1 of the measurement year that were followed by an acute readmission for any diagnosis within 30 days.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Abdominal Hysterectomy Procedures Performed (FSP-n)

Description	The number of abdominal hysterectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Inpatient Days (IPU-n)

Description	The total number of days of acute inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Inpatient Discharges (IPU-n)

Description	The total number of utilizations of acute inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Maternity Inpatient Days (IPU-n)

Description	The total number of days of acute maternity inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Maternity Inpatient Discharges (IPU-n)

Description	The total number of utilizations of acute maternity inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Medical Inpatient Days (IPU-n)

Description	The total number of days of acute medical inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Medical Inpatient Discharges (IPU-n)

Description	The total number of utilizations of acute inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Patient Stays (PCR-d)

Description	The number of acute inpatient stays with a discharge on or between January 1 and December 1 of the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Surgical Inpatient Days (IPU-n)

Description	The total number of days of acute surgical inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Acute Surgical Inpatient Discharges (IPU-n)

Description	The total number of utilizations of acute medical inpatient care and services subsequently discharged.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Adolescents (AWC-d)

Description	The number of enrolled members 12-21 years of age during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Adolescents With Well-Care Visits (AWC-n)

Description	The number of enrolled members 12-21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Antibiotic Prescriptions (ABX-n)

Description	The total number of outpatient antibiotic prescriptions during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of AOD Members (IAD-d)

Description	The number and of members with an alcohol and other drug (AOD) claim.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of AOD Members Receiving Chemical Dependency Services (IAD-n)

Description	The number of members with an alcohol and other drug (AOD) claim who received the following chemical dependency services during the measurement year: - Any service. - Inpatient. - Intensive outpatient or partial hospitalization. - Outpatient or ED.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Back Surgery Procedures Performed (FSP-n)

Description	The number of back surgery procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Bariatric Weight Loss Surgery Procedures Performed (FSP-n)

Description	The number of bariatric weight loss surgery procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Cardiac Catheterization Procedures Performed (FSP-n)

Description	The number of cardiac catheterization procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Carotid Endarterectomy Procedures Performed (FSP-n)

Description	The number of carotid endarterectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Children 3-6 Years Old (W34-d)

Description	The number of members 3-6 years of age during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Children 3-6 Years Old With PCP Well-Child Visit (W34-n)

Description	The number of members 3-6 years of age who had one or more well-child visits with a Primary Care Provider (PCP) during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Coronary Artery Bypass Graft (CABG) Procedures Performed (FSP-n)

Description	The number of coronary artery bypass graft (CABG) procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Days Supply For All Antibiotic Prescriptions (ABX-n)

Description	The total number of days supply of all outpatient antibiotic prescriptions during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Deliveries Of Live Births (FPC-d)

Description	The number of deliveries of live births between November 6 of the year prior to the measurement year and November 5 of the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of ED Visits (AMB-n)

Description	The number of visits made to an Emergency Department (ED) facility by members during the reporting year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Laparoscopic Cholecystectomy Procedures Performed (FSP-n)

Description	The number of laparoscopic cholecystectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Live Births With Expected Prenatal Visits (FPC-n)

Description	The number of Medicaid deliveries between November 6 of the year prior to the measurement year and November 5 of the measurement year that had the following number of expected prenatal visits: 21 percent of expected visits. 21 percent-40 percent of expected visits. 41 percent-60 percent of expected visits. 61 percent-80 percent of expected visits. =81 percent of expected visits.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Lumpectomy Procedures Performed (FSP-n)

Description	The number of lumpectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Mastectomy Procedures Performed (FSP-n)

Description	The number of mastectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Months (AMB-d)

Description	The total number of months that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be a point in time calculation of the number of members, at a specific date in every month (e.g. 15th) or it may be rounded sum of the number of months based on each members enrollment dates.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Months (FSP-d)

Description	The total number of months that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be a point in time calculation of the number of members, at a specific date in every month (e.g. 15th) or it may be rounded sum of the number of months based on each members enrollment dates.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Months (IPU-d)

Description	The total number of months that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be a point in time calculation of the number of members, at a specific date in every month (e.g. 15th) or it may be rounded sum of the number of months based on each members enrollment dates.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Members (MPT-d)

Description	The number of plan members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Members 15 Months Old (W15-d)

Description	The percentage of members who turned 15 months old during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Members Receiving Mental Health Services (MPT-n)

Description	The number of members receiving the following mental health services during the measurement year: - Any service. - Inpatient. - Intensive outpatient or partial hospitalization. - Outpatient or ED.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Members With Well-Child Visits In The First 15 Months Of Life (W15-n)

Description	The number of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: - No well-child visits. - One well-child visit. - Two well-child visits. - Three well-child visits. - Four well-child visits. - Five well-child visits. - Six or more well-child visits.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Years (ABX-d)

Description	The total number of years that a member has one or more active memberships, in one or more health benefits plans with pharmacy benefits, during the measurement year. This may be based on the (number of member months / 12).
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Years (AMB-d)

Description	The total number of years that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be based on the (number of member months / 12).
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Years (FSP-d)

Description	The total number of years that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be based on the (number of member months / 12).
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Member Years (IPU-d)

Description	The total number of years that a member has one or more active memberships, in one or more health benefits plans, during the measurement year. This may be based on the (number of member months / 12).
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Open Cholecystectomy Procedures Performed (FSP-n)

Description	The number of open cholecystectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Outpatient Visits (AMB-n)

Description	The number of visits made to an outpatient facility by members during the reporting year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Percutaneous Coronary Intervention (PCI) Procedures Performed (FSP-n)

Description	The number of percutaneous coronary intervention (PCI) procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Prescriptions For Antibiotics Of Concern (ABX-n)

Description	The total number of outpatient prescriptions for antibiotics of concern during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Procedures Performed (FSP-n)

Description	The number of procedures of a selected type performed during the measurement year. The procedure types relevant for this measure are: Bariatric Weight Loss Surgery Tonsillectomy or Tonsillectomy with Adenoidectomy Abdominal Hysterectomy Vaginal Hysterectomy Open Cholecystectomy Laparoscopic Cholecystectomy Back Surgery Percutaneous Coronary Intervention (PCI) Cardiac Catheterization Coronary Artery Bypass Graft (CABG) Prostatectomy Total Hip Replacement Total Knee Replacement Carotid Endarterectomy Mastectomy Lumpectomy Formula: [A or B or C or D or E or F or G or H or I or j or K or L or M or N or O or P] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Prostatectomy Procedures Performed (FSP-n)

Description	The number of prostatectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Tonsillectomy Procedures Performed (FSP-n)

Description	The number of tonsillectomy or tonsillectomy with adenoidectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Total Hip Replacement Procedures Performed (FSP-n)

Description	The number of total hip replacement procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Total Knee Replacement Procedures Performed (FSP-n)

Description	The number of total knee replacement procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Number Of Vaginal Hysterectomy Procedures Performed (FSP-n)

Description	The number of vaginal hysterectomy procedures performed on members during the measurement year.
Data Type	Standards - Data Domains.ddm/Data Domains/Count [INTEGER]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Patient Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Percentage Of Antibiotics Of Concern For All Antibiotic Prescriptions (ABX-n)

Description	The number of prescriptions for antibiotics of concern as a percentage of the total number of prescriptions for antibiotics. Formula: [(A/B) * 100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan All-Cause Readmissions (PCR)

Description	For members 18 years of age and older, the number of acute inpatient stays during the measurement year that were followed by an acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Data are reported in the following categories: 1. Count of Index Hospital Stays (IHS) (denominator). 2. Count of 30-Day Readmissions (numerator). 3. Average Adjusted Probability of Readmission. Note: For commercial, only members 18-64 years of age are reported. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Plan Member Dk

Description	A numeric surrogate key used to uniquely identify entities in the dimensional model.
Data Type	Standards - Data Domains.ddm/Data Domains/Surrogate Key Large [LONG]
Is Part Of PrimaryKey	true
Is Required	true
Is Derived	false
Is Surrogate Key	false

Well-Child Visits In The First 15 Months Of Life (W15)

Description	The percentage of members who turned 15 months old during the measurement year and who had the following number of well-child visits with a PCP during their first 15 months of life: - No well-child visits. - One well-child visit. - Two well-child visits. - Three well-child visits. - Four well-child visits. - Five well-child visits. - Six or more well-child visits. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Well-Child Visits In The Third Fourth Fifth And Sixth Years Of Life (W34)

Description	The percentage of members 3-6 years of age who had one or more well-child visits with a PCP during the measurement year. This definition is included with the permission of the National Committee for Quality Assurance (NCQA) and is an extract from the full measure definition published by NCQA. Refer to NCQA's HEDIS vol 2 measures for the complete measure definition. Formula: [(A/B) *100] (see dependencies and their labels for measures used in the formula)
Data Type	Standards - Data Domains.ddm/Data Domains/Percentage [FLOAT(2)]
Is Part Of PrimaryKey	false
Is Required	false
Is Derived	false
Is Surrogate Key	false

Relationship Details

HEDIS Utilization Analysis_Calendar Dimension_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Calendar Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HEDIS Utilization Analysis_Geographic Area Dimension_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Geographic Area Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HEDIS Utilization Analysis_Plan Member Dimension_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Plan Member Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HEDIS Utilization Analysis_Patient Dimension_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Patient Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HEDIS Utilization Analysis_Encounter Dimension_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Encounter Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

HEDIS Utilization Analysis_Analytical Classification_FK

Is Identifying Relationship	true
Child Table	HEDIS Utilization Analysis
Child Multiplicity	ZERO_TO_MANY
Child Referential Integrity: On Delete	NONE
Child Referential Integrity: On Insert	NONE
Child Referential Integrity: On Update	NONE
Parent Table	Common Code Dimension
Parent Multiplicity	ONE
Parent Referential Integrity: On Delete	NONE
Parent Referential Integrity: On Insert	NONE
Parent Referential Integrity: On Update	NONE

Primary Key Details

HEDIS Utilization Analysis PK

Key Attribute	Plan Member Dk
Key Attribute	Patient Dk
Key Attribute	Encounter Dk
Key Attribute	Analytical Classification Dk
Key Attribute	Calendar Dk
Key Attribute	Geographic Area Dk

Overview

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Dimensional Warehouse Model Data Model