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Hospital Harm - Severe Hyperglycemia

Compare Versions of: "Hospital Harm - Severe Hyperglycemia"

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Measure Information 2023 Reporting Period 2024 Reporting Period
Title Hospital Harm - Severe Hyperglycemia Hospital Harm - Severe Hyperglycemia
CMS eCQM ID CMS871v2 CMS871v3
Short Name

HH-02

HH-Hyper

NQF Number 3533e 3533e
Description

This measure assesses the number of inpatient hospital days with a hyperglycemic event (harm) per the total qualifying inpatient hospital days for that encounter for patients 18 years of age or older at admission

This measure assesses the number of inpatient hospital days for patients age 18 and older with a hyperglycemic event (harm) per the total qualifying inpatient hospital days for that encounter

Initial Population

Inpatient hospitalizations where the patient is 18 years or older at the start of the admission with a discharge during the measurement period, as well as either:

1) a diagnosis of diabetes that starts before or during the encounter; or

2) administration of at least one dose of insulin or any hypoglycemic medication during the encounter; or

3) presence of at least one blood glucose value >=200 mg/dL at any time during the encounter

The measure includes inpatient hospitalizations that began in the emergency department or in observation

Inpatient hospitalizations for patients age 18 and older that end during the measurement period, as well as either:

- A diagnosis of diabetes that starts before or during the encounter; or

- Administration of at least one dose of insulin or any hypoglycemic medication during the encounter; or

- Presence of at least one glucose value >=200 mg/dL at any time during the encounter

Denominator

Equals Initial Population

Equals Initial Population

Denominator Exclusions Inpatient hospitalizations for patients with an initial blood glucose result of >=1000 mg/dL anytime between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter Inpatient hospitalizations for patients with an initial glucose result of >=1000 mg/dL anytime between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter
Numerator

Inpatient hospitalizations with a hyperglycemic event within the first 10 days of the encounter minus the first 24 hours, and minus the last period before discharge if less than 24 hours

A hyperglycemic event is defined as:

1) A day with at least one blood glucose value >300 mg/dL;

OR

2) A day where a blood glucose test was not done, and it was preceded by two consecutive days where at

least one glucose value during each of the two days was >=200 mg/dL

Inpatient hospitalizations with a hyperglycemic event within the first 10 days of the encounter minus the first 24 hours, and minus the last period before discharge from the hospital if less than 24 hours

A hyperglycemic event is defined as:

- A day with at least one glucose value >300 mg/dL,

OR

- A day where a glucose test and result was not found, and it was immediately preceded by two contiguous, consecutive days where at least one glucose value during each of the two days was >=200 mg/dL

Numerator Exclusions

Not Applicable

Not Applicable

Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Ratio measure Ratio measure
Measure Type Outcome measure Outcome measure
Improvement Notation

A lower measure score indicates higher quality

A lower measure score indicates higher quality

Guidance

The measure is using mg/dL as the unit of measurement for glucose results.

To determine the measure outcome, the total number of hyperglycemic days during the inpatient hospitalization is divided by the total number of eligible hospital days of the inpatient hospitalization.

When evaluating for days with a blood glucose level >300 mg/dL, the first 24-hour period after admission to the hospital (including the emergency department or observation) is not evaluated to account for potentially poor glucose control outside of the hospital setting or that preceded the start of hospital care.

This measure evaluates the first 10 days of an eligible inpatient hospitalization in determining eligible days for the denominator and numerator (i.e., the length of stay is truncated to <=10 days when the length exceeds 10 days). Patients admitted for longer length of stays are more likely to have more complex medical conditions.

The numerator returns the first eligible encounter that meets the qualifying criteria: an inpatient hospitalization with a hyperglycemic event. Only one numerator is counted per encounter. Note that the Numerator returns the encounters, not days, that meet the criteria.

Blood glucose levels are determined by laboratory or point-of-care (POC) tests, including capillary/glucometer blood glucose tests.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

The measure is using mg/dL as the unit of measurement for glucose results.

To determine the measure outcome, the total number of hyperglycemic days during the inpatient hospitalization is divided by the total number of eligible hospital days of the inpatient hospitalization.

When evaluating for days with a glucose level >300 mg/dL, the first 24-hour period after admission to the hospital (including the emergency department or observation) is not evaluated to account for potentially poor glucose control outside of the hospital setting or that preceded the start of hospital care.

This measure evaluates the first 10 days of an eligible inpatient hospitalization in determining eligible days for the denominator and numerator (i.e., the length of stay is truncated to <=10 days when the length exceeds 10 days). Patients admitted for longer length of stays are more likely to have more complex medical conditions.

The “Days in Hospitalization” logic within Measure Observation 1 (associated with the denominator), in conjunction with other logic, returns the day number (e.g., day 1 to day 10) for each day within the hospitalization period to determine the eligible hospital days (e.g., from day 2 to day 10).

The “Days in Hospitalization” logic within Measure Observation 2 (associated with the numerator), in conjunction with other logic, returns the day number (e.g., day 1 to day 10) for each day within the hospitalization period to determine the eligible hyperglycemic event days (e.g., from day 2 to day 10).

Since the measure does not count any hyperglycemic events that occur in the first 24 hours, day 1 is not considered an eligible hospital day for the Measure Observations. Eligible days range from day 2 up to day 10.

Although the measure does not count any hyperglycemic events that occur in the first 24 hours as a hyperglycemic event day in Measure Observation 2, the first 24 hours of the encounter is considered day 1. This is because if there was a day during the encounter where a glucose result is not found, the measure evaluates the two days preceding to see if each had a glucose value >=200 mg/dL. The measure allows the first 24 hours of the encounter, i.e., day 1, to be one of the preceding days.

Multiple hyperglycemic events can occur during a ‘day’, but this is still considered one hyperglycemic event day.

The numerator returns the first eligible encounter that meets the qualifying criteria: an inpatient hospitalization with a hyperglycemic event. Only one numerator is counted per encounter. Note that the Numerator returns the encounters, not days, that meet the criteria.

The specimen source for the glucose test is blood, serum, plasma, or interstitial fluid, and can be obtained by a laboratory test, a Point of Care (POC) test, or a continuous glucose monitor (CGM). Glucose test results from urine specimens are not considered.

This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter that ends during the measurement period.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Next Version No Version Available
Previous Version No Version Available
Notes

*Note: There are known issues on CMS871v2. See issue EKI-18 and EKI-19 on the ONC eCQM Known Issues Dashboard for details.

Header

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Description

    Source of Change: Annual Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Annual Update

  • Updated the rationale to reflect recent evidence supporting the importance of the measure.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the Clinical Recommendation Statement to reflect current evidence.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated the definition to clarify hospital 'days' are not defined as midnight-to-midnight but are full 24-hour periods that start at the time of admission to the hospital (including emergency department and observation), excluding the last period before discharge if it is less than 24 hours.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated the guidance to provide further clarity on how hyperglycemic event days are counted.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Revised the Initial Population to reflect the updated age anchor to 18 years and older at the start of the inpatient hospitalization to harmonize with other hospital measures.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the numerator to clarify the definition of discharge as the end of the hospitalization.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Revised the descriptions of the Measure Observations to differentiate the Numerator/Denominator and the Measure Observation numerator/Measure Observation denominator ratio requirements and provide clarity.

    Measure Section: Measure Observations

    Source of Change: Measure Lead

  • Updated the narrative to reflect glucose tests and relevant results are not limited to blood specimen or laboratory or point of care test.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Revised the age anchor to 18 years and older at the start of the inpatient hospitalization to harmonize with other hospital measures.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Revised the denominator exclusion to constrain the glucose test to the qualifying encounter.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5566

  • Revised the timing associated with Laboratory Test, Performed data elements to use Global.'EarliestOf'() for the test timing to decrease implementation burden due to variable use of timing attributes for select QDM data types.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Definitions

    Source of Change: Standards/Technical Update

  • Updated the Denominator Observations and Numerator Observations functions to return 0 for the Measure Observations results for encounters that meet the Denominator Exclusion criteria.

    Measure Section: Functions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5218

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 54 ICD-9-CM codes based on validity of code during timing of look back period. Deleted 3 SNOMED CT codes (190369008, 237618001, 314771006) based on validity of code during timing of look back period.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Glucose Lab Test Mass Per Volume (2.16.840.1.113762.1.4.1248.34): Added 2 LOINC codes (1547-9, 99504-3) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hypoglycemics Treatment Medications (2.16.840.1.113762.1.4.1196.394): Added 1 RxNorm code (2589008) based on review by technical experts, SMEs, and/or public feedback. Added 2 RxNorm codes (2599362, 2619152) based on terminology update. Added 6 RxNorm codes (2601743, 2601755, 2601761, 2601767, 2601773, 2601784) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Deleted 39 RxNorm codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024