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Hospital Harm – Severe Hypoglycemia

CMS Measure ID
CMS816v0
Version
0
NQF Number
Not Applicable
Measure Description

This measure assesses the proportion of encounters of patients 18 years of age or older at admission, who were administered at least one antihyperglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter. Harm (numerator) is defined as a test for blood glucose with a result less than 40 mg/dL, where the antihyperglycemic medication was given within the 24 hours prior to the start of the low blood glucose event (and administered during the encounter). Only one severe hypoglycemic event is counted per encounter.

Initial Population

All encounters when the patient is 18 years of age or older at the start of the encounter, and at least one antihyperglycemic medication was administered during the encounter. Measure includes instances of administration of antihyperglycemic agents in the emergency department or in observation status at the start of an inpatient admission when assessing inclusion of encounters in the measure denominator.

Denominator Statement
Denominator Exclusions

None

Numerator Statement

All encounters which include:

1. A severe hypoglycemic event during the encounter, defined as a test (laboratory or point-of-care (POC)) for blood glucose with a result less than 40 mg/dL;

AND

2. An antihyperglycemic medication administration within 24 hours prior to the start of the severe hyperglycemic event (and that was during the encounter);

AND

3. No subsequent repeat test (laboratory or POC) for blood glucose with a result greater than 80 mg/dL within five minutes of the start of the initial low blood glucose test.

Only the first qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter. The 24-hour and 5-minute timeframes are based on the time the blood glucose was drawn, as this reflects the time the patient was experiencing that specific blood glucose level.

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Scoring
Measure Type
Improvement Notation

A lower proportion indicates better quality.

Guidance

To calculate the hospital-level measure result, divide the total numerator events by the total number of eligible encounters (denominator).

For each encounter, qualifying encounters (denominator) include all patients 18 years of age or older at the start of the encounter, who had at least one antihyperglycemic medication administered during the encounter.

To create the numerator, for each encounter identify:

1. Any instance of a test for blood glucose with a result less than 40 mg/dL during the encounter (severe hypoglycemic event), with an anti-hyperglycemic medication administered within 24 hours preceding the event and during the encounter (including emergency department and observation stays contiguous with the admission).

A severe hypoglycemic event is defined as a test (laboratory or point-of-care (POC)) for blood glucose with a result less than 40 mg/dL. The 24-hour timeframe extends from the end of the medication administration to the start of the blood glucose test.

2. Do not include any severe hypoglycemic events (identified in Step 1) which were followed by a repeat test (laboratory or POC) for blood glucose with a result greater than 80 mg/dL within five minutes of the start of the initial low blood glucose test.

Rationale: This is done to remove false positives that can occur in POC testing. The 5-minute timeframe extends from the start of the severe hypoglycemic test to the start of the repeat hypoglycemic test.

Only the first qualifying severe hypoglycemic event is counted in the numerator, and only one severe hypoglycemic event is counted per encounter.

Meaningful Measure
Notes

Pre-rulemaking

Specifications

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Last Updated: Oct 10, 2019