While most people think glycemic management is only a concern for people living with diabetes, in the inpatient setting there’s a lot more nuance: over one third of hospitalized patients experience hyperglycemia, and CMS recently announced two new quality metrics that highlight the need to better manage these patients’ blood glucose during their hospital stay, and also underscores the risks of not taking action.
During a Glytec-sponsored webinar in September hosted by Becker's Hospital Review, Jordan Messler, MD, SFHM, FACP, Chief Medical Officer at Glytec, discussed how best in class glycemic management programs strategically leverage people, process and technology to achieve their goals. He also explained the impact and details for two new CMS reporting metrics.
Danielle Scheurer, MD, MSCR, SFHM, Chief Quality Officer for the Medical University of South Carolina Hospital in Charleston, shared how MUSC has used other electronic clinical quality measures to drive change and provide a consistent metric of performance, and also offered a plan of action for others to implement or expand on glycemic management quality programs to strategically leverage the new eCQMS to improve patient safety and quality of care in the hospital.
Four insights:
1. One of the main barriers to understanding the performance of a glycemic management program is the lack of relevant data. While many patients, not just those living with diabetes, require insulin during a hospital stay, most hospitals do not have an automated capability to extract and analyze glucose data, Dr. Messler said.
"It's a real challenge to improve if we can't measure," he added. "Many institutions don't have reliable ways to measure [glucose data], and even if they do, it's very difficult to benchmark and understand what success means."
Hospitals may not see the true impact of delaying care or not treating persistent hyperglycemia, or have the data to understand the causes of preventable severe hypoglycemia. While studies have shown that optimal glycemic management improves patient outcomes, reduces length of stay, and reduces cost of care, hospitals need to be able to analyze and understand their own data.
2. CMS has created new metrics focused on eliminating severe hospital-induced hypoglycemia and prioritizing early treatment and optimal management of severe hyperglycemia. These two measures will be added to CMS's eCQM list by fiscal year 2023. Hospitals should implement reporting packages by January 2023. Data on eCQMs will be collected throughout 2023 and are expected to be reported to the public in 2024. By fiscal year 2025, financial penalties will begin to be enforced for those who don't report on glycemic eCQMs.
3. MUSC uses eCQMs to provide a quality structure to drive performance. According to Dr. Scheurer, the MUSC team has been big fans of eCQMs. "They're very efficient and a way to extract good quality information from the EMR," she said. "With significant federal support for transitioning to eCQMs, we can substantially reduce the burden of reporting. It requires far fewer human resources and gives you a holistic picture of performance." Dr. Scheurer said the biggest challenge is that it requires very structured data entry, which often falls to already overburdened clinicians.
Previously, their cross-functional stroke/neuro QAPI (Quality Assessment / Performance Improvement) team used 4 eCQMs related to stroke performance to measure the impact of their efforts, and was able to track improvement over 4 years.
4. Hospitals should begin by choosing a data reporting system and establishing a multidisciplinary team to meet upcoming CMS glycemic eCQM requirements. Dr. Scheurer advised that hospitals start by working with their quality and information system teams to figure out how to extract the required data, looking at both hypoglycemia and hyperglycemia. "After you form a multidisciplinary glycemic team, perform a gap analysis of your current program and then deeply look at the processes driving those outcomes to see where improvement is needed," she added.
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