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  2. CQM-6591

What does this Logic Intend to do in Denominator Exclusion for Glucose >=1000

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      Thank you for your inquiry specific to CMS871v3 Hospital Harm – Severe Hyperglycemia. We will explain the “where not” expression by starting with a look at the Denominator Exclusion’s "Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start” definition, shown below. We see it references two other define statements in bold (please see attachment for color distinctions of the text):

       
      define “Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”

      "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" GlucoseResult1000

        where not ( GlucoseResult1000.id in "Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start".id )

       
      The first one (we’ll call it Expression 1), "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”, looks for a glucose with a result >=1000 during the 7-hour interval (between 1 hour prior to and 6 hours after the encounter start).

      The second one (we’ll call it Expression 2), “Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”, looks to see if there is any glucose with a result earlier than the glucose with a result >=1000 during the 7-hour interval.

      The ‘where not’ used in the logic captures a glucose >=1000 within the 7-hour window (Expression 1) where there is NOT an earlier glucose test (Expression 2). This ensures that the glucose w/result >=1000 within the 7-hour window is in fact the earliest (i.e., initial) test.

       
      We appreciate the feedback included in your inquiry. We will consider providing clarifying information in the measure specification during the upcoming eCQM Annual Update cycle.
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      Thank you for your inquiry specific to CMS871v3 Hospital Harm – Severe Hyperglycemia. We will explain the “where not” expression by starting with a look at the Denominator Exclusion’s "Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start” definition, shown below. We see it references two other define statements in bold (please see attachment for color distinctions of the text):   define “Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start” "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" GlucoseResult1000   where not ( GlucoseResult1000.id in "Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start".id )   The first one (we’ll call it Expression 1), "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”, looks for a glucose with a result >=1000 during the 7-hour interval (between 1 hour prior to and 6 hours after the encounter start). The second one (we’ll call it Expression 2), “Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”, looks to see if there is any glucose with a result earlier than the glucose with a result >=1000 during the 7-hour interval. The ‘where not’ used in the logic captures a glucose >=1000 within the 7-hour window (Expression 1) where there is NOT an earlier glucose test (Expression 2). This ensures that the glucose w/result >=1000 within the 7-hour window is in fact the earliest (i.e., initial) test.   We appreciate the feedback included in your inquiry. We will consider providing clarifying information in the measure specification during the upcoming eCQM Annual Update cycle.
    • CMS0871v3
    • It's unclear what measure logic should be doing in the logic that starts "Where not.....

      What is the Purpose of the "Where Not "part of the Denominator Exclusion Logic of a Glucose >= 1000?

      Is it saying that there can't be any Glucose results in the timeframe of 1 hour before to 6 hours after the start of the HospitalizationInterval, that are before the Glucose of >=1000?, no matter what that earlier glucose result is? That if there is an earlier glucose to the >=1000  glucose result, that the Denominator Exclusion is not valid?

      • Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start *

      • from
        "Initial Population" InpatientHospitalization,
        ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] GlucoseTest
        let HospitalizationInterval: Global."HospitalizationWithObservation" ( InpatientHospitalization ),
        GlucoseTestTime: Global."EarliestOf" ( GlucoseTest.relevantDatetime, GlucoseTest.relevantPeriod )
        where GlucoseTest.result >= 1000 'mg/dL'
        and GlucoseTest.result is not null
        and GlucoseTestTime during Interval[( start of HospitalizationInterval - 1 hour ), ( start of HospitalizationInterval + 6 hours )]
        return GlucoseTest 

      • Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start *

      • from
        "Initial Population" InpatientHospitalization,
        "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" GlucoseResult1000,
        ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] EarlierGlucoseTest
        let HospitalizationInterval: Global."HospitalizationWithObservation" ( InpatientHospitalization ),
        GlucoseTest1000Time: Global."EarliestOf" ( GlucoseResult1000.relevantDatetime, GlucoseResult1000.relevantPeriod ),
        EarlierGlucoseTestTime: Global."EarliestOf" ( EarlierGlucoseTest.relevantDatetime, EarlierGlucoseTest.relevantPeriod )
        where GlucoseTest1000Time during Interval[( start of HospitalizationInterval - 1 hour ), ( start of HospitalizationInterval + 6 hour )]
        and EarlierGlucoseTestTime during Interval[( start of HospitalizationInterval - 1 hour ), GlucoseTest1000Time )
        and EarlierGlucoseTest is not null
        and EarlierGlucoseTest.id !~ GlucoseResult1000.id
        return GlucoseResult1000 

      • Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start *

      • "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" GlucoseResult1000 where not ( GlucoseResult1000.id in "Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start".id )

        1. Response to CQM-6591.pdf
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            JLeflore Mathematica EH eCQM Team
            megbutler Margaret Butler
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