Thank you for your inquiry specific to CMS871v3 Hospital Harm – Severe Hyperglycemia. The scenario you provided does not qualify for the denominator exclusion. Assuming the glucose test with value 1200 mg/dL is 10:30 AM, and the inpatient encounter starts at 4:00 PM and ends at 7:00 PM, the exclusion is not met because the glucose of >=1000 mg/dL does not occur between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter. Please let us know if our assumptions regarding AM / PM for the encounter and glucose test times are incorrect. We hope this helps.

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

It seems to me that the response to Query 2 provided on 6/23/2023 at 12:28 PM is not correct.

There is a statement in there that I believe is not accurate. I have copied the response provided to query 2 below and the underlined statement does not seem right.

"Response to Query 2: The measure logic continues to check for the first glucose lab test value when evaluating for the denominator exclusion using the timing function ‘Global.EarliestOf’ instead of using the ‘first’ operator in the logic. Using this function in the denominator exclusion logic returns the earliest glucose lab test based on the relevant date time or the start of the relevant period of the lab test, as long it meets the other denominator exclusion logic requirements such as the timing elements (e.g., the glucose lab test occurs within 1 hour prior to and 6 hours after the start of the encounter)."

My understanding is that the ‘Global.EarliestOf’  (e.g. Global."EarliestOf" (GlucoseTest.relevantDatetime, GlucoseTest.relevantPeriod )) is used to evaluate the earliest between the relevantDatetime and the relevantPeriod and NOT the FIRST glucose among a series of glucose tests performed. So, if there were 2 lab tests for glucose within the 7 hours and one was at 8 AM and other 8:30 AM (assume encounter start is at 9 AM) , the ‘Global.EarliestOf’ will not help you locate the 8 AM lab test.  Can someone please help review this explanation.

Thanks!

sgearhart, Any update on ticket.

Request you to look into the comments where we have added the question.

Thank you.

yanheras, Thank you for the answer.

sgearhart we have added a follow up question in the comment section. Could you please provide us the response.

Thank you.

Hi SimranM2,

Does this solution answer your question?

If you have no follow up questions, this ticket will be considered resolved and closed on Wednesday, July 12.

Thank you.

The “Laboratory Test, Performed” is reported using the Laboratory Test Performed template.

The EarlierGlucoseTest.id and the GlucoseResult1000.id are both represented using the Observation.id attribute in the Laboratory Test Performed template.  The combination of the id @root and @extension (if @extension is present) is the key element to identify unique instances of these lab tests. 

Hello,

Awaiting the response of the ticket.

Thank you.

Thank you for submitting a ticket to the QRDA JIRA Issue Tracker. Our experts are reviewing your ticket and will provide feedback as soon as possible. Thank you for your patience.

​Hello and thank you for the inquiry about CQM871v3 Hospital Harm – Severe Hyperglycemia.

​Response to Query 1: The denominator exclusion criteria is: Inpatient hospitalizations for patients with an initial glucose result of >=1000 mg/dL anytime between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter.

Both scenarios provided meet the denominator exclusion because the glucose tests occurred within 1 hour prior to the start of the encounter. The encounter starts in the ED and/or Observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other.

Response to Query 2: The measure logic continues to check for the first glucose lab test value when evaluating for the denominator exclusion using the timing function ‘Global.EarliestOf’ instead of using the ‘first’ operator in the logic. Using this function in the denominator exclusion logic returns the earliest glucose lab test based on the relevant date time or the start of the relevant period of the lab test, as long it meets the other denominator exclusion logic requirements such as the timing elements (e.g., the glucose lab test occurs within 1 hour prior to and 6 hours after the start of the encounter).

Response to Query 3: Your understanding of ‘.id’ in the logic is correct. The ‘.id’ is an attribute for Laboratory Test, Performed and is used to identify a specific instance of that lab test data element. EarlierGlucoseTest.id !~ GlucoseResult1000.id, in the above logic, ensures a glucose test that occurs before the glucose result >= 1000 ‘mg/dL’ during the 7-hour interval is not the same glucose test.

For the QRDA portion of your question, we will reassign your ticket to the QRDA Issue Tracker. We hope this helps.

Hello Team,

We have one additional question mentioned below:

Patient C aged 21 years with

Start of InpatientEncounter.relevantPeriod = 11/12/2024 4:00

End of InpatientEncounter.relevantPeriod = 11/12/2024 7:00

having first Glucose Lab Test Mass Per Volume documented on 11/12/2024 10:30 with value 1200 mg/dL.

#Query :

Will the above patient qualify for exclusion?

Request you to provide us with the resolution urgently as our client deliverables are dependent on it.

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Hi Team,

Gentle reminder to provide us with the response.

Thankyou.

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.