Brief Description of Measure: CMS871/HH-Hyper: Hospital Harm - Severe Hyperglycemia 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 Description of Issue: Emerging evidence indicates that the presence of any extremely high glucose level >=1000 during the initial 7-hour timeframe will need to be titered down slowly, which may inappropriately trigger the numerator. The measure developer proposes revising the denominator exclusion to exclude patients with any 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.

Proposed Solution: Revise the denominator exclusion to inpatient hospitalizations for patients with any glucose test - instead of the 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. CURRENT: Encounter with First Glucose Greater Than or Equal to 1000 "Initial Population" InpatientHospitalization   with "Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" FirstGlucoseResult     such that FirstGlucoseResult.result is not null       and FirstGlucoseResult.result >= 1000 'mg/dL'       and Global."EarliestOf" ( FirstGlucoseResult.relevantDatetime, FirstGlucoseResult.relevantPeriod ) during Interval[( start of Global."HospitalizationWithObservation" ( InpatientHospitalization ) - 1 hour ), ( start of Global."HospitalizationWithObservation" ( InpatientHospitalization ) + 6 hours )]   return InpatientHospitalization PROPOSED: Encounter with Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start "Initial Population" InpatientHospitalization   with ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] GlucoseTest     such that GlucoseTest.result is not null       and GlucoseTest.result >= 1000 'mg/dL'       and Global."EarliestOf" ( GlucoseTest.relevantDatetime, GlucoseTest.relevantPeriod ) during Interval[( start of Global."HospitalizationWithObservation" ( InpatientHospitalization ) - 1 hour ), ( start of Global."HospitalizationWithObservation" ( InpatientHospitalization ) + 6 hours )]       and Global."EarliestOf" ( GlucoseTest.relevantDatetime, GlucoseTest.relevantPeriod ) before end of InpatientHospitalization.relevantPeriod   return InpatientHospitalization Rationale for Change: Revisions to the denominator exclusion as proposed are supported by clinical evidence.