different, , each by race/ethnicity ED visits per Encounters per thousand HSCRC Casemix All population for covered capita Data zips, high utilization set, target population if different, , each by race/ethnicity Readmissions All Cause 30-day Readmits CRISP High utilization set, target (see HSCRC specs) population if different, each by race/ethnicity Potentially (see HSCRC specifications) PAU Patient High utilization set, target avoidable Level Reports population if different, utilization each by race/ethnicity Patient % rating 9 or 10 HCAPHS High utilization set, target experience population if different, each by race/ethnicity Table 2. Core Process Measures Measure Definition Source Population(s) expected Use of Encounter % of inpatient discharges that CRISP All population for covered Notification Alerts result in an Encounter zips, high utilization set, Notification System alert going target population if to a physician different Completion of % High utilizers with completed Hospital, High utilization set, target health risk Health Risk Assessments Partnership, population if different assessments Collaboration Established % of High Utilizers Patients Hospital, High utilization set, target longitudinal care with completed care Partnership, population if different plan Collaboration Shared Care % of patients with care plans CRISP High utilization set, target Profile with data shared through HIE in population if different Care Profile
different, , each by race/ethnicity ED visits per capita Encounters per thousand HSCRC Casemix Data All population for covered zips, high utilization set, target population if different, , each by race/ethnicity Readmissions All Cause 30-day Readmits (see HSCRC specs) CRISP High utilization set, target population if different, each by race/ethnicity Potentially avoidable utilization (see HSCRC specifications) PAU Patient Level Reports High utilization set, target population if different, each by race/ethnicity Patient experience % rating 9 or 10 HCAPHS High utilization set, target population if different, each by race/ethnicity Table 2. Core Process Measures Measure Definition Source Population(s) expected Use of Encounter Notification Alerts % of inpatient discharges that result in an Encounter Notification System alert going to a physician CRISP All population for covered zips, high utilization set, target population if different Completion of health risk assessments % High utilizers with completed Health Risk Assessments Hospital, Partnership, Collaboration High utilization set, target population if different Established longitudinal care plan % of High Utilizers Patients with completed care Hospital, Partnership, Collaboration High utilization set, target population if different Shared Care Profile % of patients with care plans with data shared through HIE in Care Profile CRISP High utilization set, target population if different