CMS measure specification: Hospital Harm – Hypoglycemia.

In by Susan Lawrence

What do you need to know about the Centers for Medicare & Medicaid Services (CMS) proposed hypoglycemia measure?

Measure Intent

Better Quality of Care

This measure would incentivize hospitals to implement clinical workflows that facilitate evidence-based management of diabetes to reduce the likelihood of hypoglycemia events.

Improved Patient Outcomes

This measure may result in fewer patients experiencing adverse events associated with low blood sugar, such as acute symptoms including dizziness, confusion or loss of consciousness.

Measure Description

The proportion of hospitalized patients age 18 years and older with hypoglycemia.

Hypoglycemia Definition

A glucose value of less than 40 mg/dL following the administration of an antihyperglycemic medication in the 24 hours prior to the low blood glucose event, and with no subsequent lab test for glucose with a resulting value greater than 80 mg/dL within five minutes of the low glucose event.

Measure Rationale

  • Hypoglycemia events in the hospital are among the most common adverse drug events. In 2004, an estimated 888,000 adverse drug events (ADEs) occurred among hospitalized Medicare patients in the United States.1,2
  • In a study published by the Office of the Inspector General (OIG), ADEs represent one-third of all adverse events in hospitals among Medicare patients; of those events, hypoglycemia represented the third most common ADE.3 Hypoglycemia is associated with increased in-hospital mortality,4,5,6 longer hospital stays,4,6,7 and higher medical costs.4
  • Rates of inpatient hypoglycemia events are considered an indicator of the quality of care provided by a hospital. Severe hypoglycemia events are largely avoidable by careful use of antihyperglycemic medication. Moreover, the rate of severe hypoglycemia varies across hospitals, indicating an opportunity for improvement in care.
  • The Agency for Healthcare Research and Quality (AHRQ) identified insulin and other hypoglycemic agents as high alert medications and associated adverse events to be included as a measure in the Medicare Patient Safety Monitoring System (MPSMS).1
  • Measuring hypoglycemia events in the hospital setting will provide hospitals with reliable and timely measurement of their hypoglycemia event rates. This will fill a gap in measurement and provide incentives for hospital quality improvement.

Measure History

This measure is a re-specification of a National Quality Forum endorsed measure of hypoglycemia (NQF # 2363 Glycemic Control – Hypoglycemia), originally developed by the Health Services Advisory Group (HSAG). NQF #2363 measure was fully developed, but was not electronically specified and is not in use in CMS programs. Hypoglycemia is a high priority measurement area identified as part of the Hospital Harm Performance Measure development and therefore we are adapting and re-specifying the NQF endorsed measure for future CMS use.



  1. Classen, D.C., Jaser, L. & Budnitz, D.S. (2010). Adverse drug events among hospitalized Medicare patients: epidemiology and national estimates from a new approach to surveillance. Jt. Comission J Qual Patient Saf, 36(1), 12-21.
  2. National Quality Forum. (2010). Prioritization of high-impact Medicare conditions and measure gaps: measure prioritization advisory committee report. Washington, D.C.: NQF. Retrieved from MeasurePrioritizatinAdvisoryCommitteeReport2010-05-24.
  3. Office of the Inspector General. (2010). Adverse events in hospitals: national incidence among Medicare beneficiaries. OIG. Retrieved from
  4. Curkendall, S. M., Natoli, J. L., Alexander, C. M., Nathanson, B. H., Haidar, T., & Dubois, R. W. (2009). The economic and clinical impact of inpatient diabetic hypoglycemia. Endocr Pract, 15(4), 302- 312.
  5. Krinsley, J. & Grover, A. (2007). Severe hypoglycemia in critically ill patients: risk factors and outcomes. Critical Care Medicine, 35(10), 2262-2267.
  6. Turchin, A., Matheny, M. E., Shubina, M., Scanlon, J. V., Greenwood, B., & Pendergrass, M. L. (2009). Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care, 32(7), 1153-1157.
  7. Krinsley, J., Schultz, M. J., Spronk, P. E., van Braam Houckgeest, F., van der Sluijs, J. P., Melot, C., & Preiser J. (2011). Mild hypoglycemia is strongly associated with increased intensive care unit length of stay. Annals of Intensive Care, 1(49).