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  2. CQM-5612

CRP: Add option for interstitial fluid specimen to meet glucose lab requirement

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    • Resolution: Unresolved
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      Brief description of measure
      CMS816/HH-01: Hospital Harm- Severe Hypoglycemia:
      The proportion of inpatient hospitalizations for patients 18 years of age or older at admission, who were administered at least one hypoglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter.
      Harm (numerator) is defined as a laboratory or point-of-care (POC) test for blood glucose with a result less than 40 mg/dL, where the hypoglycemic 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 inpatient hospitalization encounter.

      CMS871/HH-02: Hospital Harm- Severe Hyperglycemia:
      This measure assesses the number of inpatient hospital days with a hyperglycemic event (harm) per the total qualifying inpatient hospital days for patients 18 years of age or older at admission.

      Description of issue
      Glucose lab test results are evaluated in the CMS 816 Hypoglycemia measure's numerator, and in the CMS 871 Hyperglycemia measure's denominator and numerator. ​Currently, the measures use the value set "Glucose Lab Test Mass Per Volume" (OID 2.16.840.1.113762.1.4.1248.34) which includes code concepts of a blood glucose specimen (e.g., 2345-7 Glucose [Mass/volume] in Serum or Plasma) and are not based on the device used, as the criteria is looking to capture just the result from a single point in time.

      During the last maintenance cycle, AIR received feedback from pre-rulemaking public comment requesting we consider allowing the use of a continuous glucose monitor (CGM) specimen, interstitial fluid, for inclusion into the glucose lab test value set. Part of our response for not including CGM readings was that at the time (3/2021), we did not find a LOINC code to represent “glucose in interstitial fluid” taken from a single point in time, which would likely require a new LOINC code request. Since that time, LOINC added such a code in their February 2022 release v2.72: https://loinc.org/99504-3/. The description is: "Glucose [Mass/volume] in Interstitial fluid". The timing is ‘Pt’, meaning a single point in time. This aligns with the intent of the measure.

      Goal of review
      Obtain clinical feedback
      Show
      Brief description of measure CMS816/HH-01: Hospital Harm- Severe Hypoglycemia: The proportion of inpatient hospitalizations for patients 18 years of age or older at admission, who were administered at least one hypoglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter. Harm (numerator) is defined as a laboratory or point-of-care (POC) test for blood glucose with a result less than 40 mg/dL, where the hypoglycemic 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 inpatient hospitalization encounter. CMS871/HH-02: Hospital Harm- Severe Hyperglycemia: This measure assesses the number of inpatient hospital days with a hyperglycemic event (harm) per the total qualifying inpatient hospital days for patients 18 years of age or older at admission. Description of issue Glucose lab test results are evaluated in the CMS 816 Hypoglycemia measure's numerator, and in the CMS 871 Hyperglycemia measure's denominator and numerator. ​Currently, the measures use the value set "Glucose Lab Test Mass Per Volume" (OID 2.16.840.1.113762.1.4.1248.34) which includes code concepts of a blood glucose specimen (e.g., 2345-7 Glucose [Mass/volume] in Serum or Plasma) and are not based on the device used, as the criteria is looking to capture just the result from a single point in time. During the last maintenance cycle, AIR received feedback from pre-rulemaking public comment requesting we consider allowing the use of a continuous glucose monitor (CGM) specimen, interstitial fluid, for inclusion into the glucose lab test value set. Part of our response for not including CGM readings was that at the time (3/2021), we did not find a LOINC code to represent “glucose in interstitial fluid” taken from a single point in time, which would likely require a new LOINC code request. Since that time, LOINC added such a code in their February 2022 release v2.72: https://loinc.org/99504-3/ . The description is: "Glucose [Mass/volume] in Interstitial fluid". The timing is ‘Pt’, meaning a single point in time. This aligns with the intent of the measure. Goal of review Obtain clinical feedback
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      Proposed solution
      Add LOINC 99504-3 "Glucose [Mass/volume] in Interstitial fluid" to the "Glucose Lab Test Mass Per Volume" (OID 2.16.840.1.113762.1.4.1248.34) value set.

      Rationale for change
      ​Including glucose values taken as a single point in time from interstitial fluid will align with those hospitals that have adopted CGM as a tool to monitor glucose levels.
      Show
      Proposed solution Add LOINC 99504-3 "Glucose [Mass/volume] in Interstitial fluid" to the "Glucose Lab Test Mass Per Volume" (OID 2.16.840.1.113762.1.4.1248.34) value set. Rationale for change ​Including glucose values taken as a single point in time from interstitial fluid will align with those hospitals that have adopted CGM as a tool to monitor glucose levels.

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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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