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: Updated American Diabetes Association (ADA) guidelines allow higher blood sugar levels for terminally ill patients: “Glycemic levels >250 mg/dL (13.9 mmol/L) may be acceptable in terminally ill patients with short life expectancy. In these individuals, less aggressive insulin regimens to minimize glucosuria, dehydration, and electrolyte disturbances are often more appropriate. (Wang, 1995, referenced in ADA, 2023)." To account for glycemic control leniency for terminally ill patients, the measure developer proposes excluding inpatient hospitalizations for patients with comfort care measures ordered or provided to them during the encounter, or if discharged to hospice care from the hospital.

Proposed Solution: Add new Denominator Exclusions:   "Encounter with Discharge for Hospice Care"   union "Encounter with Comfort Measures during Hospitalization"   Using these proposed definitions: define Encounter with Discharge for Hospice Care   "Initial Population" InpatientHospitalization   where InpatientHospitalization.dischargeDisposition in "Discharged to Home for Hospice Care"       or InpatientHospitalization.dischargeDisposition in "Discharged to Health Care Facility for Hospice Care"       define Encounter with Comfort Measures during Hospitalization  "Initial Population" InpatientHospitalization  with "Comfort Measures Care" ComfortCare   such that Coalesce(start of Global."NormalizeInterval"    (ComfortCare.relevantDatetime, ComfortCare.relevantPeriod), ComfortCare.authorDatetime)during Global."HospitalizationWithObservation" ( InpatientHospitalization ) define Comfort Measures Care  ["Intervention, Order": "Comfort Measures"]  union ["Intervention, Performed": "Comfort Measures"] Rationale for Change: The additional denominator exclusions will allow for appropriate glycemic control leniency for terminally ill patients. This will align with the measure intent.