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Hospital Harm - Acute Kidney Injury

Compare Versions of: "Hospital Harm - Acute Kidney Injury"

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Measure Information 2025 Reporting Period
Title Hospital Harm - Acute Kidney Injury
CMS eCQM ID CMS832v1
Short Name HH-AKI
NQF Number Not Applicable
Description

The proportion of inpatient hospitalizations for patients age 18 and older who have an acute kidney injury (stage 2 or greater) that occurred during the encounter. Acute kidney injury (AKI) stage 2 or greater is defined as a substantial increase in serum creatinine value, or by the initiation of kidney dialysis (continuous renal replacement therapy (CRRT), hemodialysis or peritoneal dialysis).

Initial Population

Inpatient hospitalizations for patients age 18 and older without a diagnosis of obstetrics, with a length of stay of 48 hours or longer, and who had at least one serum creatinine value after 48 hours from the start of the encounter

Denominator

Equals Initial Population

Denominator Exclusions Inpatient hospitalizations for patients with an increase in serum creatinine value of at least 0.3 mg/dL between the index serum creatinine and a subsequent serum creatinine taken within 48 hours of the encounter start.Inpatient hospitalizations for patients with the index eGFR value of <60 mL/min within 48 hours of the encounter start. Inpatient hospitalizations for patients who have less than two serum creatinine results within 48 hours of the encounter start.Inpatient hospitalizations for patients who have kidney dialysis (CRRT, hemodialysis or peritoneal dialysis) initiated 48 hours or less after the encounter start, and who do not have evidence of a 2 times increase in serum creatinine. Inpatient hospitalizations for patients with at least one specified diagnosis present on admission that puts them at extremely high risk for AKI:   Hemolytic Uremic Syndrome (HUS)Large Body Surface Area (BSA) Burns  Traumatic Avulsion of Kidney  Rapidly Progressive Nephritic Syndrome  Thrombotic Thrombocytopenic Purpura      Inpatient hospitalizations for patients who have at least one specified procedure during the encounter that puts them at extremely high risk for AKI:   Extracorporeal membrane oxygenation (ECMO)  Intra-Aortic Balloon Pump  Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)  Nephrectomy
Numerator

Inpatient hospitalizations for patients who develop AKI (stage 2 or greater) during the encounter, as evidenced by:

A subsequent increase in serum creatinine value at least 2 times higher than the lowest serum creatinine value, and the increased value is greater than the highest sex-specific normal value for serum creatinine.

Or:

Kidney dialysis (CRRT, hemodialysis or peritoneal dialysis) initiated more than 48 hours after the start of the encounter, and who do not have evidence of a 2 times increase in serum creatinine.

Numerator Exclusions

Not applicable

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure
Measure Type Outcome measure
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 qualifying encounters (denominator).

Qualifying encounters (denominator) include all inpatient hospitalizations for patients 18 years of age or older at the start of the encounter without a diagnosis of obstetrics, with a length of stay of 48 hours or longer, and who had at least one serum creatinine value after 48 hours from the start of the encounter.

Exclude encounters that do not have at least two serum creatine values within 48 hours of arrival. Two values are needed within this timeframe to determine if the patient has AKI or moderate-to-severe renal dysfunction on arrival.

For encounters that show no patients with identified harm of 2.0 increase in serum creatinine, query for initiation of renal dialysis during hospitalization, defined by the start of dialysis occurring during the encounter.

  • If dialysis starts more than 48 hours after the start of the encounter, this meets numerator criteria.
  • If dialysis starts 48 hours or less after the start of the encounter, this meets denominator exclusion criteria.

Encounters for patients with an increase in serum creatinine value of at least 0.3 mg/dL between the index serum creatinine and any subsequent serum creatinine taken within 48 hours of the encounter start are excluded. Due to the variability of decimal precision within programming languages and calculation tools, the value of >=0.3 is expressed in the logic as >0.299.

Note the measure is currently confined to using mg/dL as the unit of measurement for creatinine and mL/min as the unit of measurement for eGFR results.

Only one harm is counted per encounter.

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 eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

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Previous Version No Version Available
Notes

*This is a risk adjusted measure.

Risk Adjustment Methodology Report: Acute Kidney Injury's Risk Adjustment Methodology Report (Updated June 20, 2023)

Last Updated: Dec 28, 2023