This measure assesses the number of hospital days with a hyperglycemic event (harm) per the total qualifying hospital days among inpatient encounters for patients 18 years and older at the start of the measurement period.
All encounters where the patient is 18 years or older at the start of the measurement period with an inpatient hospital 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 encounters that began in the Emergency Department or in observational status.
Denominator: Equals Initial Population
All encounters 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 was not measured, and it was preceded by two consecutive days where at least one glucose value during each of the two days was >=200 mg/dL.
Hyperglycemia, i.e., elevated blood glucose level, is common among hospitalized patients, especially those with preexisting diabetes (Swanson, et al., 2011; Umpierrez et al., 2012). Hyperglycemia can also affect individuals with no prior history of diabetes and may be induced by medications such as steroids, or parenteral (intravenous) or enteral (tube) feeding.
Severe hyperglycemia, i.e., extremely elevated blood glucose level, is significantly associated with a range of harms, including increased in-hospital mortality, infection rates, and hospital length of stay (Pasquel, et al., 2010; Rady, et al., 2005; Umpierrez, et al., 2002; Falciglia et al., 2009; Lee et al., 2012; King et al., 2011; Jackson et al., 2012; Umpierrez et al., 2012; Krinsley 2003). Lower rates of inpatient severe hyperglycemia may not only improve care for patients, but also reduce costs for healthcare payers (Krinsley 2003; Newton et al., 2006; Krinsley et al., 2016). The rate of hyperglycemia varies across hospitals, suggesting opportunities for improvement in inpatient glycemic management (Swanson et al., 2011; Cook et al., 2009; Matheny et al., 2008). The rate of inpatient hyperglycemia can be considered a marker for quality of hospital care, since inpatient hyperglycemia is largely avoidable with proper glycemic management. The use of evidence-based standardized protocols and insulin management protocols have been shown to improve glycemic control and safety (Maynard et al., 2015; Donihi et al., 2006).