Sign of the times…the potential new eCQMS part 2

September 16th, 2019 / By Cheryl Manchenton, RN

As I mentioned in my previous blog, the sign of the times in health care can often be reflected in the proposed (and confirmed) new electronic Clinical Quality Measures (eCQMs). Last time we discussed the proposed eCQM for pressure injuries. Today, we will talk about the proposed eCQM for hypoglycemia. The Final Rule is again sending a clear message to healthcare organizations concerning the direction for quality of care measures. 

Pressure ulcers have long been monitored, but hypoglycemia was only transiently monitored via the National Surgical Quality Improvement Project (NSQIP). It is also monitored by AHRQ in the Medicare Patient Safety Monitoring System (MPSMS) via chart-abstracted data.

Per the Final Rule, hypoglycemic events are among the most common adverse drug events and are defined as a blood glucose level of less than 70 mg/dL. CMS has noted hypoglycemic events were associated with a higher in-hospital mortality, increased length of stay and consequently, increased resource use. Studies from 2003-2004 noted an increase in 2.8 days, average cost increase of 38.9 percent, and increased odds of being discharged to a skilled nursing facility than diabetics without hypoglycemic episodes.1 They also noted that the most common causes of hypoglycemia include lack of sufficient caloric intake, overuse of antidiabetic medications or both.2

CMS has stated there is great variability in rates of severe hypoglycemia (<40mg/dL) among healthcare organizations. They also say hypoglycemic episodes are largely avoidable via careful use of anti-diabetic medication and close monitoring of blood glucose. Hence, CMS believes hypoglycemic events should be addressed via the IQR program.

The proposal to monitor severe hypoglycemic event incidence is via direct abstraction from the EHR (not claims-based/administrative data as with HACs, PPCs and PSIs or chart-abstracted data via MPSMS). The measure only includes patients with severe hypoglycemic events within 24 hours of the administration of an antihyperglycemic medication, without a subsequent laboratory test for glucose greater than 80 dL/ml within 5 minutes of the low glucose result.  The measure was originally endorsed by the National Quality Forum (NQF) (Glycemic control -severe hypoglycemia #2363) and this current eCQM is provisionally endorsed by them pending rereview and testing. Other parameters being defined include numerator (total number of events per hospitalization versus number of hospitalizations with at least one event). Note that the current eCQM is designed to measure the number of hospitalizations with at least one hypoglycemic event. There are also no numerator exclusions at this point.

Also keep in mind that CMS is currently developing a severe hyperglycemia eCQM, so stay tuned! This is merely a proposed eCQM (as is the pressure injury eCQM), but it is moving through the NQF endorsement process and what remains to be determined surrounds populations (or excluded ones), reporting structures, and logistics such as type of antidiabetic medications being monitored.

In my next blog, I will discuss the third proposed eCQM (rate of nulliparous women with a normal-term, singleton fetus in the vertex position undergoing C-section).

There are clear signs of the times and I would refer you to our October Quality Webinar on the FY2020 Final Rule changes impacting quality (current changes, not proposed).

Cheryl Manchenton is a senior inpatient consultant and project manager for 3M Health Information Systems.

Read part one and part three of the series.


References

1Curkendall, S. M., Natoli, J. L., Alexander, C. M., Nathanson, B. H., Haidar, T., & Dubois, R. W.

(2009). Economic and clinical impact of inpatient diabetic hypoglycemia. Endocrine Practice, 15(4):

302-312.

2American Diabetes Association. 14. Diabetes care in the hospital: Standards of Medical Care in

Diabetesd2018. Diabetes Care 2018;41(Suppl. 1):S144–S151