Brief description of measure CMS816: Hospital Harm - Severe Hypoglycemia: 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. CMS819: Hospital Harm - Opioid-Related Adverse Events: This measure assesses the proportion of inpatient hospital encounters where patients ages 18 years of age or older have been administered an opioid medication and are subsequently administered an opioid antagonist (naloxone) within 12 hours, an indication of an opioid-related adverse event. This measure excludes opioid antagonist (naloxone) administration occurring in the operating room setting. CMS871: 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 that encounter for patients 18 years of age or older at admission. Description of issue ​During Summer 2022, feedback from external review included a recommendation to revise the age requirement of 18 and older to be at the start of inpatient hospitalization, instead of at the start of emergency department and/or observation stay if those visits preceded the inpatient admission. Goal of review Obtain clinical feedback

Proposed solution CMS816 Header: CURRENT Description: 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 PROPOSED Description: Inpatient hospitalizations for patients age 18 and older who were administered at least one hypoglycemic medication during the encounter and who suffer the harm of a severe hypoglycemic event during the encounter CURRENT Initial Population: Inpatient hospitalizations where the patient is 18 years of age or older at the start of the encounter, and at least one hypoglycemic medication was administered during the encounter PROPOSED Initial Population: Inpatient hospitalizations for patients age 18 and older and at least one hypoglycemic medication was administered during the encounter CMS819 Header: CURRENT Guidance: Qualifying encounters (denominator) include all patients 18 years of age or older at the start of the encounter with at least one opioid medication administered during the encounter. PROPOSED Guidance: Qualifying encounters (denominator) include all patients age 18 and older with at least one opioid medication administered during the encounter. CMS871 Header: CURRENT 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 PROPOSED 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 age 18 years and older CURRENT 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 PROPOSED Initial Population: Inpatient hospitalizations where the patient is age 18 and older 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 CMS816, CMS819, CMS871: CURRENT Logic: define "Qualifying Encounter"    ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter   where InpatientEncounter.relevantPeriod ends during day of "Measurement Period"     and AgeInYearsAt(date from start of Global."HospitalizationWithObservation"(InpatientEncounter))>= 18 PROPOSED Logic: define "Qualifying Encounter"     ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter   where InpatientEncounter.relevantPeriod ends during day of "Measurement Period"     and AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod)>= 18 Rationale for change The approach to anchor the age to the start of the inpatient hospitalization, instead of the emergency department and/or observation stay, harmonizes with other EH eCQMs.