patient experience
pt_exp_scrDefinition
ISO-11179 Definition
A composite measure of patient-reported perceptions of the quality of their interactions with the healthcare system encompassing access to care, communication with providers, care coordination, shared decision-making, and overall satisfaction with the care received. Patient experience is distinct from patient satisfaction in that it measures objective experiences — whether the doctor explained things clearly, whether care was coordinated between providers, whether appointments were available in a timely manner — rather than subjective feelings about the care encounter. Patient experience data is collected through standardized surveys including CAHPS for health plans, HCAHPS for hospitals, and CG-CAHPS for physician practices.
CMS Star Ratings weight patient experience measures heavily, and poor patient experience scores can prevent plans from achieving four-star quality bonus payment thresholds even when clinical quality measures perform well. Healthcare data teams analyze pt_exp_scr by provider, service line, and member demographic segment to identify specific care experience deficiencies driving low scores and measure the impact of patient experience improvement initiatives on subsequent survey results.
Standard Abbreviation
pt_exp_scr
Category
Production DDL — FACT_QUALITY_MEASURE
CREATE OR REPLACE TABLE FACT_QUALITY_MEASURE (
qlty_key INTEGER NOT NULL -- surrogate key,
mbr_key INTEGER NOT NULL -- FK to DIM_MEMBER,
plan_key INTEGER NOT NULL -- FK to DIM_PLAN,
meas_yr SMALLINT -- measurement year,
hedis_meas_cd VARCHAR(20) -- HEDIS measure code,
denom_ind CHAR(1) -- denominator eligible,
numer_ind CHAR(1) -- numerator met,
excl_ind CHAR(1) -- exclusion indicator,
gap_open_ind CHAR(1) -- care gap open,
star_rtg_nbr DECIMAL(3,1) -- star rating,
qlty_scr DECIMAL(5,2) -- quality score,
perf_thrsh_pct DECIMAL(5,2) -- performance threshold,
raf_scr DECIMAL(10,3) -- risk adjustment factor,
outreach_cnt SMALLINT -- outreach attempts,
load_dt TIMESTAMP_NTZ NOT NULL -- load timestamp
);
Standard Snowflake DDL for the canonical quality table. Convert to BigQuery or Databricks →
Why This Term Matters
Quality measure data determines how payers and providers are rated and reimbursed under CMS Stars, HEDIS, and value-based care contracts. Data engineers who understand quality terminology build measure calculation pipelines that correctly attribute patients, apply denominator exclusions, and flag documentation gaps before submission deadlines. Incorrect quality data directly affects star ratings, pay-for-performance bonuses, and Medicare Advantage plan bids.
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