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Hospital Harm - Severe Hyperglycemia

Compare Versions of: "Hospital Harm - Severe Hyperglycemia"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

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Table Options
Measure Information 2025 Reporting Period
Title Hospital Harm - Severe Hyperglycemia
CMS eCQM ID CMS871v4
Short Name

HH-Hyper

CBE ID* 3533e
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Description

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

Measure Scoring Ratio measure
Measure Type Outcome
Stratification

None

Risk Adjustment

None

Rationale

Hyperglycemia, i.e., elevated glucose level, is common among hospitalized patients, especially those with preexisting diabetes (Umpierrez et al., 2012) and accounts for over 30% of noncritically ill hospitalized patients (Korytkowski, 2022). Hyperglycemia can also affect individuals with...

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Clinical Recommendation Statement

Multiple guidelines address recommended levels of glycemic control, though these do not define severe hyperglycemia:

From Section 16, Diabetes Care in the Hospital, in the Standards of Medical Care in Diabetes by the American Diabetes Association, (American Diabetes Association, 2023):

16....

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Improvement Notation

A lower measure score indicates higher quality

Definition

Inpatient hospitalizations: Includes time in the emergency department and observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other.

This measure defines a severe hyperglycemic day (harm) as either (1) a...

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Guidance

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

When evaluating for days with a glucose level >300 mg/dL, the first 24-hour period after admission to the hospital is not evaluated to account for potentially poor glucose control outside of the hospital setting or...

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Initial Population

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 the end of the encounter; or

- Administration of at least one dose of insulin or any hypoglycemic medication that starts during...

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Denominator

Equals Initial Population

Denominator Exclusions

-Inpatient hospitalizations for patients with a 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 who have comfort care measures ordered or provided during the...

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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 from the hospital if less than 24 hours.

A hyperglycemic event is defined as:

- A day with at least one glucose value >300...

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Numerator Exclusions

Inpatient hospitalizations that meet the Denominator Exclusions:

-Inpatient hospitalizations for patients with a 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...

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Next Version No Version Available
Previous Version

Header

  • Updated the eCQM version number.

    Measure Section:

    eCQM Version Number

    Source of Change:

    Annual Update

  • Changed all references from NQF to CBE to identify the consensus-based entity role.

    Measure Section:

    CBE Number

    Source of Change:

    Annual Update

  • Updated copyright.

    Measure Section:

    Copyright

    Source of Change:

    Annual Update

  • Moved recommendation from the Endocrine Society from the Rationale section to the Clinical Recommendation Statement, which is the more appropriate location.

    Measure Section:

    Rationale

    Source of Change:

    Measure Lead

  • Moved statement regarding intent of the measure from the Clinical Recommendation Statement to the Rationale section, which is the more appropriate location.

    Measure Section:

    Rationale

    Source of Change:

    Measure Lead

  • Moved recommendation from the Endocrine Society from the Rationale section to the Clinical Recommendation Statement, which is the more appropriate location.

    Measure Section:

    Clinical Recommendation Statement

    Source of Change:

    Measure Lead

  • Moved statement regarding intent of the measure from the Clinical Recommendation Statement to the Rationale section, which is the more appropriate location.

    Measure Section:

    Clinical Recommendation Statement

    Source of Change:

    Measure Lead

  • Updated the Guidance to clarify the inpatient hospitalization admission starts in the emergency department (ED) or observation when the transition between the ED encounter, observation encounter, and the inpatient encounter are within an hour or less of each other.

    Measure Section:

    Guidance

    Source of Change:

    ONC Project Tracking System (JIRA): CQM-6572

  • Added a denominator exclusion for inpatient hospitalizations for patients with comfort measures ordered or provided during the encounter, or who had a discharge disposition to home or a health care facility for hospice care.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Revised the denominator exclusions to include inpatient hospitalizations for patients with 'any' glucose test - instead of an 'initial' glucose test - between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter with a result of >=1000 mg/dL based on clinical review.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added a numerator exclusion for inpatient hospitalizations that meet the denominator exclusions to align with measure intent to prevent cases from processing to the measure observations if the denominator exclusions are met.

    Measure Section:

    Numerator Exclusions

    Source of Change:

    Measure Lead

  • Updated the Measure Observations to clarify Observation 2, associated with the numerator of the ratio, does not include cases that meet the Numerator Exclusions criteria.

    Measure Section:

    Measure Observations

    Source of Change:

    Measure Lead

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

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

  • Updated references and measure header to reflect current evidence and new or updated literature.

    Measure Section:

    Multiple Sections

    Source of Change:

    Measure Lead

Logic

  • Revised the denominator exclusions to include inpatient hospitalizations for patients with 'any' glucose test - instead of an 'initial' glucose test - between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter with a result of >=1000 mg/dL based on clinical review.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added a denominator exclusion for inpatient hospitalizations for patients with comfort measures ordered or provided during the encounter, or had a discharge disposition to home or a health care facility for hospice care.

    Measure Section:

    Denominator Exclusions

    Source of Change:

    Measure Lead

  • Added a numerator exclusion for inpatient hospitalizations that meet the denominator exclusions to align with measure intent to prevent cases from processing to the measure observations if the denominator exclusions are met.

    Measure Section:

    Numerator Exclusions

    Source of Change:

    Measure Lead

  • Revised the measure observations' definitions by removing the logic that prevents them from calculating when denominator exclusions are met, as this is check is being performed with a new numerator exclusion.

    Measure Section:

    Measure Observations

    Source of Change:

    Measure Lead

  • Renamed value set to 'Payer Type' to more accurately reflect the contents and intent of the value set.

    Measure Section:

    Definitions

    Source of Change:

    Standards/Technical Update

  • 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 version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Definitions

    Source of Change:

    Annual Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v8.0.000 and the library name from 'MATGlobalCommonFunctions' to 'MATGlobalCommonFunctionsQDM.'

    Measure Section:

    Functions

    Source of Change:

    Annual Update

Value Set

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

  • Added new Type 2 diabetes treatment medication 'bexagliflozin' to 'Hypoglycemics Treatment Medications' value set based on review by technical experts, SMEs, and/or public feedback.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added new Type 2 diabetes treatment medication 'sotagliflozin' to 'Hypoglycemics Treatment Medications' value set based on review by technical experts, SMEs, and/or public feedback.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Comfort Measures (1.3.6.1.4.1.33895.1.3.0.45) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Value set Diabetes (2.16.840.1.113883.3.464.1003.103.12.1001): Deleted 1 SNOMED CT code (314904008) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Added value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209) based on change in measure requirements/measure specification.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Value set Hypoglycemics Treatment Medications (2.16.840.1.113762.1.4.1196.394): Added 4 RxNorm codes (2621571, 2637859, 2638683, 2638691) based on review by technical experts, SMEs, and/or public feedback. Added 9 RxNorm codes (2642808, 2644768, 379804, 2644396, 2644401, 2644405, 2644409, 2644413, 2644417) based on terminology update. Deleted 7 RxNorm codes (2380248, 2380265, 861787, 861790, 2371734, 860999, 899989) based on terminology update.

    Measure Section:

    Terminology

    Source of Change:

    Measure Lead

  • Value set (2.16.840.1.114222.4.11.3591): Renamed to Payer Type based on recommended value set naming conventions.

    Measure Section:

    Terminology

    Source of Change:

    Annual Update

Last Updated: Feb 17, 2025