Medicare member
Item
aetna medicare (pffs, hmo/ppo fully insured) individual members, plus medicare members from any plan sponsor that has agreed it would like its members to be included
boolean
C0018717 (UMLS CUI [1,1])
C0680022 (UMLS CUI [1,2])
Chronic heart failure | At risk of disease Score
Item
member meets aetna health profile database criteria for chronic heart failure (disease management eligibility = y) with a disease risk stratification score of 3 -
boolean
C0264716 (UMLS CUI [1])
C1281905 (UMLS CUI [2,1])
C0449820 (UMLS CUI [2,2])
High risk of Hospital Readmission
Item
5 (moderately severe to severe). these proprietary criteria yield a group of individuals for whom historical claims data estimates a substantial risk of hospital readmission within the coming 6 months.
boolean
C0332167 (UMLS CUI [1,1])
C0600290 (UMLS CUI [1,2])
Hospital admission | Emergency department visit Quantity
Item
acute inpatient admission or 2 or more emergency room visits within 6 months prior to identification
boolean
C0184666 (UMLS CUI [1])
C0586082 (UMLS CUI [2,1])
C1265611 (UMLS CUI [2,2])
Residence Geographic area Designated
Item
residence in the designated geographic areas selected for the study (the planned source population is all new jersey, new york, pennsylvania and north central aetna individual medicare members and north central. if members identified from these states have not filled the study within three months, the source population may be expanded to include aetna's north central region members in illinois and ohio. these north central members would include all aetna medicare individual members in these areas, plus any group medicare members from groups whose plan sponsors agree that the study may be offered to the members.)
boolean
C0237096 (UMLS CUI [1,1])
C0017446 (UMLS CUI [1,2])
C1524084 (UMLS CUI [1,3])
Member Active Case management
Item
member may be currently open/ active in case management
boolean
C0680022 (UMLS CUI [1,1])
C0205177 (UMLS CUI [1,2])
C0085971 (UMLS CUI [1,3])
Telephone Available
Item
responds telephonic outreach to offer study participation, or to interactive voice response outreach call, and confirms each of:
boolean
C0039457 (UMLS CUI [1,1])
C0470187 (UMLS CUI [1,2])
PATIENT IDENTITY Confirmation
Item
their own identity {secure health insurance portability accountability act (hipaa) compliant acknowledgement to caller}
boolean
C0747303 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
Heart condition
Item
that they have been told of having a heart condition
boolean
C3842523 (UMLS CUI [1])
Study Subject Participation Status
Item
interest in hearing more and possibly participating in the study
boolean
C2348568 (UMLS CUI [1])
Member Case management Stop
Item
member had case management and this was closed within the 30 days prior to identification for the study
boolean
C0680022 (UMLS CUI [1,1])
C0085971 (UMLS CUI [1,2])
C2746065 (UMLS CUI [1,3])
Cessation of life | End stage cancer | Kidney Failure, Chronic | Hospice patient | Alzheimer's Disease Late stage | Dementia | Artificial Ventricle | Heart Transplantation | Heart Transplantation Program
Item
end-of life, terminal cancer, end stage renal disease, hospice, late stage alzheimer's disease, dementia, ventricular assist device, heart transplant or active in heart transplant program. excluded diagnoses or conditions will be identified where it is evident through aetna's health profile data diagnoses in claims, or upon case management assessment.
boolean
C0011065 (UMLS CUI [1])
C0741884 (UMLS CUI [2])
C0022661 (UMLS CUI [3])
C0745035 (UMLS CUI [4])
C0002395 (UMLS CUI [5,1])
C0683337 (UMLS CUI [5,2])
C0497327 (UMLS CUI [6])
C0085842 (UMLS CUI [7])
C0018823 (UMLS CUI [8])
C0018823 (UMLS CUI [9,1])
C3484370 (UMLS CUI [9,2])
Intravenous medication Heart failure
Item
chronic or ongoing intravenous heart failure medication
boolean
C0812149 (UMLS CUI [1,1])
C0018801 (UMLS CUI [1,2])
Telephone call Response Interest Lacking
Item
any response to interactive voice response outreach call other than "yes, i am interested"
boolean
C0302186 (UMLS CUI [1,1])
C2911692 (UMLS CUI [1,2])
C0543488 (UMLS CUI [1,3])
C0332268 (UMLS CUI [1,4])