[CQM-6574] CMS871v3 - Requesting help understanding the new function - "Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start" Created: 11/08/23  Updated: 12/15/23  Resolved: 11/28/23

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals Priority: Moderate
Reporter: Manish Parekhji Assignee: Joelencia Leflore
Resolution: Answered Votes: 0
Labels: None

Attachments: PNG File image-2023-11-08-12-31-14-475.png     PNG File image-2023-11-08-12-31-20-588.png     PNG File image-2023-11-08-12-35-50-491.png     PNG File image-2023-12-01-12-59-20-514.png     PNG File image-2023-12-01-13-00-52-152.png    
Solution: Thank you for your inquiry specific to CMS871v3 Hospital Harm – Severe Hyperglycemia. Although the intent of the denominator exclusion has not changed from the previous version, the logic was revised to ensure the glucose tests are constrained to only the qualifying encounter, and to decrease data processing performance issues by restricting evaluation to only the pertinent glucose test data elements.

Looking at the "Initial Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start” definition, we see it references two other define statements in bold:

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, "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 a 7-hour interval (between 1 hour prior to and 6 hours after the encounter start).

The second one, “Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start”, evaluates to see if there were any glucose tests with a result >=1000 earlier than the start of the 7-hour window.

The ‘where not’ used here is to capture an initial glucose >=1000 within the 7-hour window where there is NOT a glucose test earlier that has a result >=1000. This ensures that only the initial glucose w/result within the 7-hour window, and not before, is evaluated.

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.
Solution Posted On:
2024 Reporting Period EH/CAH eCQMs:
CMS0871v3
Last Commented Date:

 Description   

In the latest version of this measure (HH-Hypo v3) I'm trying to understand the new definition that was previously not there in v2-
"Glucose Tests Earlier Than Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start"

What is the need to check for an earlier lab test glucose, if you have already found the earliest glucose that is >= 1000 using the following definition - "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start"

So, I'm requesting help in understanding the need for the following 2 definitions -

 

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

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

 

Also, note the definition of the exclusion, has remained exactly the same between v2 and v3 and yet the logic of the eCQM has 2 additional functions and I'm trying to understand why?

Thanks in advance for your guidance.

 

 

 Comments   
Comment by Joelencia Leflore [ 12/15/23 ]

Thank you for your follow-up inquiry specific to CMS871v3 Hospital Harm – Severe Hyperglycemia. At a high level what this logic aims to do is constrain the glucose evaluation to only the glucose results performed during the qualifying encounter within the 7-hour window. In the previous version of the measure, if a patient met the denominator exclusion in an earlier hospital visit, the exclusion was applied to subsequent encounters. This version of the logic was required in order to resolve this issue and prevent the evaluation of any glucose >=1000 that was within the 7-hour window from a previous encounter to be captured in any subsequent qualifying encounters.

Comment by Joelencia Leflore [ 12/11/23 ]

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

Comment by Manish Parekhji [ 12/01/23 ]

Hi there,

Thanks for the explanation. I appreciate it. 

Unfortunately, I'm still struggling to understand the need for these additional definitions. 

To me, given an encounter start date/time, you can find the 7 hour range and then using the FIRST function, find the first Glucose within those 7 hours. Then if that first glucose returned is >= 1000 then encounter is excluded otherwise not. Once you find the first glucose using the FIRST function, I'm not understanding what other glucose value can be obtained before that first glucose. My understanding of the logic is, find the very first glucose within the 7 hours in relation to the encounter start date/time and if it is >=1000 it is a denominator exclusion. 

The following logic from the CY2023 functions make much more sense to me. Seems like the logic in 2024 has been made more complicated but I'm failing to understand the need for it. 

Thanks!

Comment by Joelencia Leflore [ 11/17/23 ]

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.

Comment by Manish Parekhji [ 11/09/23 ]

We are struggling to understand why this denominator exclusion logic was changed between 2023 and 2024. It seems that even the updated logic is trying to achieve the exact same thing - i.e. the measure is trying to get to the very first glucose test during the 7 hour interval from the admit date/time and once you find it, if the value of that first glucose is >= 1000 mg/dl, then episode is in Den Exclusion, otherwise it is not in denominator exclusion. 

Example - 
Inp Admit:     10/14/2023 8 AM
Glucose Lab Test time range - (1 hour before and 6 hours after) = 7 AM to 2 PM

Scenario A - Not in Den Exclusion
First(
Glucose:     10/14/2023 7:00 AM - 800 mg/dl - Not in Den Exclusion
Glucose:     10/14/2023 10 AM - 1001 mg/dl
)

Scenario B - In Den Exclusion
First(
Glucose:     10/14/2023 7:00 AM - 1003 mg/dl - In Den Exclusion
Glucose:     10/14/2023 10 AM - 1001 mg/dl
)

It seems that the logic in 2023 was much easier to follow. The updated logic in 2024 seems to add complexity and we are trying to understand the reason for the updated logic in 2024 when the 2023 simpler logic was able to achieve exactly the same thing. Thanks again for your guidance.

Comment by Joelencia Leflore [ 11/09/23 ]

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

Comment by Manish Parekhji [ 11/08/23 ]

Please note that I did look at https://oncprojectracking.healthit.gov/support/browse/CQM-6220 where this item/question is discussed but even after reviewing the response, I'm still not clear on the 2 new definitions in v3 i.e. why is the eCQM trying to find another lab test value prior to the earliest lab test value obtained from the definition "Glucose Greater Than or Equal to 1000 within 1 Hour Prior To and 6 Hours After Encounter Start".

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