Learn from one of the field’s most prominent experts and CQO of UC Davis Health, Gregory Maynard, MD, MS, MHM regarding his CQO perspective on glycemic control and proven QI strategies needed to prepare for and meet the active CMS, and forthcoming NHSN and CDC glycemic measures.


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Jordan Messler: Hi, I'm Jordan Messler, the Chief Medical Officer at Glytec. I'm thrilled to introduce our next speaker, Dr. Greg Maynard, who will be discussing preparing for the CMS glycemic measures. Dr. Maynard is a national expert on quality improvement, systems improvement, and particularly improving glycemic management in the hospital.

He's the current Chief Quality Officer at UC Davis in Sacramento. I've known Greg for over 15 years where any conversation with him turns into a masterclass in quality improvement. He's done groundbreaking work in mentored improvement, real time interventions, which he's called Measureventions.

Hundreds of hospitals and hospitalists have used Greg's work to drive improvement and save lives. He's implemented high quality bundles of care to reduce preventable hypoglycemia, and proven how data can be used to drive change. He's also integral in the development of these national measures around glycemic control, and there's no one better to speak about the measures and how to think about QI in the hospital. Dr. Maynard, thanks so much for joining us today.

Gregory Maynard: Thank you, Jordan. That was a wonderful and flattering introduction. Thanks very much. Um, okay, so today, um, are they, are they able to see my, the slides now… not clear to me.

Jordan Messler Yep, you're good to go. 

Gregory Maynard: Okay. Alright, so today we'll be talking again as Jordan talked about inpatient glycemic control. And in particular, we'll be talking a lot about the role of the new CMS electronic quality measures, and then right on the horizon following those. The new NHSN or CDC metrics that are to follow that, I think will be real game changers.

All right, so I've been at this a long time, as Jordan alluded to, my history is very much intertwined with the Society of Hospital Medicine, or SHM, and that I share, I've been sharing work with SHM and collaborating with people through that organization for decades. So, I first got into the game when I was Division Chief of Hospital Medicine at UC San Diego and I started some work there based on some upsetting cases where we had some hypoglycemic events that I thought were totally preventable.

We started a SHM glycemic control task force, and I got to know many excellent endocrinologists, some of whom have spoken this same kind of series and it was really it's been great to collaborate with them and to help build tools like a glycemic control resource room, a series of articles that were turned into a supplement for the Journal of Hospital Medicine, etc.

In 2009, after realizing that it was hard to manage what you couldn't measure, we constructed some metrics at UC San Diego, some GlucoMetrics, if you will, to look at just how much hyperglycemia and hypoglycemia, we had, of course, at that time, there was no way to compare that to other sites. So I collaborated with SHM again.

We imported our metrics up to SHM so that hospitals could upload their data. We would then use our techniques to create these GlucoMetrics as a range of measures, some of which you'll be seeing, and then we started benchmarking. We started benchmarking in terms of, you know, 100 plus hospitals, we'd look at their performance and the acute care units, and we'd look at their performance in the critical care units, and we could rank them and look at how they were doing relative to one another.

We continue to refine those metrics. We imported it to another place in REDCap. And we recently completed our 21st round of SHM benchmarking, which sites use to gauge their progress. And to prioritize what they need to work on we, and the course of all this work, we created this, basically an implementation guide. It's still available on the SHM website, parts of it need to be updated in terms of the greater prevalence of insulin pumps coming in and patients and things like that. But for the most part the basics remain the basics and there's a nice section in there about metrics and data collection.

If what I'm saying today doesn't stick, just quickly why we measure well, you do have to measure where you're at and you have to know where you're at to know where you're going. So there is that plus that measurement can sometimes raise attention and awareness that you're not really doing as well as you thought you were.

I've talked to many hospitals who start the benchmarking and they're shocked sometimes to see their numbers because they thought they were doing okay, and they find out they're in the bottom quartile, and that's an eye opener. It helps to also assure staff that as you implement protocols, you're actually doing good, not harm, and to reassure yourself of that as well, because there is a trade off between hypoglycemia and really tight glycemic control.

But generally, hospitals can get better at both glycemic control and hypoglycemia. At the same time, providing they follow the principles that we'll be going over, it's good to compare like units to each other, and that really helps in GlucoMetrics. If you're able to do that, it helps you prioritize efforts.

For example, you might be doing really well in your care units, but not so well in your acute care units and so it helps you in that fashion. It helps you also assess the tradeoffs between hyper and hypoglycemia. So if you see that you've got a high hypoglycemia rate, you might have to modify your glycemic target, or make sure you get that part down, the safe use of insulin before you start pushing down on the glycemic target.

That comparing yourself to other hospitals, I think, is really key. And then, Jordan did mention this active surveillance or measurevention. That's not available through SHM, but it really helps if you can see who's in a hospital right now, who's either hypoglycemic or almost hypoglycemic, or who's out of control, in order to be able to triage those patients to see if they need further action early on in their course, instead of waiting until they're gone to figure out.

This is one example of the way we present the GlucoMetrics benchmarking. Each bar represents a hospital's performance. In this case, this is the percent of patients with a day weighted mean greater than or equal to 180 milligrams per deciliter. In other words, if you add up their day 1, day 2, and day 5, have the average of each one of those days and divide by the number of days.

And it's over 180. That means that your control was bad, basically, for the entire hospitalization. You were not able to get that mean for the stay, basically, down under 180. That, as you can see, is quite variable in this ranking bar chart. You can see some are able to get it down to 10 or 15 percent of patients.

Others are up in the 40s or 45%. The red bar is, when they enter their hospital number in this benchmarking system, it highlights their performance, so they can easily distinguish it from everybody else's. And that green line is the median, so you can tell where you're at compared to the median performance.

We, in doing this, and by using a scatter plot I'll show you shortly, we identify not only the top performers and then have them give webinars on how they achieve success. But we also identify the worst performers, and we have reached out to them, surveyed them to find out why they're bottom performers, and then tried to coach them out of the basement.

So we'll be talking about that a little bit as well. This is an example of that scatter plot I was talking about, and it's a little hard to look at at first. But basically, it's a way to look at the tradeoffs between hyper and hypoglycemia in one chart. Hypoglycemia in this case is on the x axis, and lower is better, so further to the left is better.

And then glycemic control, or uncontrolled hyperglycemia, is on the y axis. And again, the lower the better. So that happy face means that those hospitals were able to achieve top quartile performance in both hypo and hyperglycemia simultaneously. On the flip side, the people out here in this upper outer quadrant, were in the worst quartile of both.

So those are the terrible 10, as we call them, or, you know, however many were in that quadrant. Those are the people who qualify for extra coaching because they're in serious trouble with very high rates of hyper and hyperglycemia at the same time.

So, as you saw from those plots, there is... a lot of variation across hospitals, and there is a reason for that. Hospitals have highly variable prioritization for glycemic control and there have been no national metrics until now, so there is no way to really gauge where you're at unless you do it locally, participating in SHM, maybe you're participating in Glytec, or some other way to measure, but basically, most hospitals do not have a way to compare their performance to other hospitals across the country.

And the, you know, hospitals vary by availability of expertise and the passion to do this work. The people who do well do have those and they also have metrics and an institutional role to standardize. Sometimes that support comes from an anecdote of a patient getting really, really hypoglycemic and ill.

Sometimes it's a VIP that's admitted that. Calls up your executive suite and says, I have type 1 diabetes and my care was terrible. But basically, a lot of things have to go right to become an excellent performance.

This is the new eCQM, which was validated and endorsed by NQF - it's around severe hypoglycemia, it's the number of admissions with the blood glucose less than 40 milligrams per deciliter, preceded by anti-diabetes drug within 24 hours of the event, and the denominator is the number of admissions with greater than one, one or greater than one,anti-diabetic agent administered.

The exclusions were possible spurious reads, and this is an adults only measure, only those 18 or older. The complement to this measure, looking for hyperglycemia, severe hyperglycemia. It's a number of inpatient days, with blood glucose greater than 300 mg per deciliter. So note the first measure, again, the denominator is STAYS.

And in this measure, the denominator is patient days, with blood glucose, qualifying hospital days for patients greater than, patient 18 years of age. And they had to have some marker that they were at risk for hyperglycemia. So a diagnosis of diabetes, administration of an anti diabetes drug, or sugar is greater than or equal to 200 during their stay.

So if they hit one of those, they're in the denominator, and then they look at the number of inpatient days from all those qualifying days, how many were, uh, greater than 300. That's a level where everyone can agree is too high and can lead to frank electrolyte disturbance. Osmotic diuresis, certainly more prone to infections, etc.

So how are eCQMs used? They're part of the hospital inpatient quality reporting system. It's a pay for reporting system and if you don't report as specified, then you're subject to quite a reduction in your CMS reimbursement. So CMS just recently removed five measures that had served their purpose as people were always routinely doing well on them.

And then they replaced them with the current measures, two of which are the ones you just saw. One for hypo and one for hyperglycemia. That measurement year began in calendar year 23, so it's beginning this year. Not every hospital is going to pick those because you have some flexibility. You don't have to pick all of them.

You have to pick a mandatory one for opioid, for an eCQM around opioid use, but otherwise, you pick from a menu, so not everyone's going to pick some, pick these measures, but a lot will, and even if you don't pick those measures, it's likely someone in your hospital knows or will know how you're doing on those measures because as CQO, I know that we, look at these measures, we validate them, and then we choose which ones to report.

So, basically, what's the financial impact? Well, initially, maybe not much because they're probably doing reporting, but these measures, once they're better established, can get embedded in Stars reports, Leapfrog, Vizient, hack reduction programs, some of which have fiscal penalty or potential fiscal reward.

You can expect that these eCQMs, this will garner some more support and institutional attention for glycemic control efforts, and if they're not aware now, you can use this webinar to go and tell them, hey, this is coming, or it's here, and we should at least know how we're doing on this. It's fairly straightforward to do these eCQMs.

Most hospitals can do them and validate them without a lot of trouble. But, as an example, we, this is our spreadsheet where we track what we're looking at. The green are the ones that are chart abstracted measures. The blue ones are the ones that we're currently reporting, and the yellow ones are the ones that are under validation, including, right now, the hospital harm ones for severe hypoglycemia and the hospital harm ones for severe hyperglycemia.

So, even though we're not reporting on those, in other words, I know they exist. I'm going to know what our performance is, and it will raise awareness, most likely amongst your executive suite somewhere.

Now, some things to think about. These measures, I would not rely on these measures to help you improve care. They are to raise awareness of the issues, but they are totally inadequate to probably help guide improvement efforts. That's because they're really limited. They only tell you when you're at the extremes of hypo and hyperglycemia.

And remember, there's no analysis by unit or even types of unit. So they take all the measures for both critical care units and acute care units and throw them all together and give you one number. And so it's very hard to tell from that one number where you need to improve or how to prioritize.

There's no risk adjustment for the type of patients you see. And there's no risk adjustment for the type of hospital you are. So if you're a large, major one, trauma center with a burn center and, you know, all that stuff. You're likely to have a riskier population than a smaller community hospital. They don't have any measures for, like, less than 70 mg per deciliter or less than 54.

And I think those are more common and easier to track and trend than the... Pretty much never events that less than 40 milligrams per deciliter represent. There are no measures for timeliness of management for hypoglycemia. And we see in benchmarking that people are shocked when they see how long it takes them to resolve a documented case of hypoglycemia.

Some of that's documentation and some of it is lack of attentiveness to the therapy, and there's no measures for how often you're in range, and there's no clue about what your insulin use patterns are. So for all those reasons, from a quality improvement perspective, these measures are far from adequate or desirable in guiding your improvement efforts.

So you need local measures, or you need SHM measures, or you need Glytec measures, or you need another set of measures. And these could be homegrown. Some places you might be able to purchase them and, you know, you can get monthly or quarterly reporting, benchmarking against others, the active surveillance we talked about, and then separate reporting for. I'm going to talk about a couple of different kinds of units or really what you're looking at is different kinds of therapy with infusion therapy being the usual in critical care units and subcutaneous insulin being the usual in acute care units with some exceptions in both settings.

Inroads on glycemic control, it's good to have a dedicated team that has at least some protected time to do this work. Not everybody has to have protected time, but somebody should have protected time to help manage this. It's really a program that needs to be managed, not just a project. In fact, glycemic control is a series of projects if you think about it.

It's SubQ, it's IV infusion, it's a transition from one to the other. It's how you start insulin when somebody gets admitted. It's how you transition them home. It's a perioperative setting. It's what you do for special situations like TPN. So, it's a series of projects that really deserves to be a program with some dedicated support and a lot of volunteer and multidisciplinary support.

That team needs to be empowered to standardize care and they need to be empowered to take that standardization and embed it in clinical decision support, in your electronic health record, in your policies in your algorithms and tools that nudge and provide clinical decision support. It really helps if you can have some of those measures, not just be month to month and quarter to quarter, but real time.

So you can pull up a list of the patients right now who are at risk and then have the resources to triage some of those outliers and see what needs to be done. If you need to nudge a provider to add insulin or to, insulin, or, or whatever. And then again, there's multiple areas in it. You know, people do well if they have the C Suite's attention and the support, so ideally your institutional scorecard would have some of these GlucoMetrics on them so that your executive staff are aware of this and they're sending a message that it's important.

So I just told you how long, well, we've been waiting a long time for eCQMs, but then I kind of dissed them because they're good probably for garnering support and for getting attention, but they're not adequate for guiding quality improvement. The good news is that if you, even if you don't have any local metrics, I think there are really excellent metrics on the horizon that will essentially be done for you.

Through the efforts of NHSN, which is a surveillance network, does work for the CDC. So basically the same group catalogs and tracks your hospital acquired infections, like CAUTI and CLABSI and C DEF and SSI, et cetera, that group has devised a way to automatically electronically, upload your data, manipulate it in a similar way that we do at SHM, only with the added advantage that they're also getting insulin data and other anti hypo, anti hyperglycemic med information, and so they're going to be able to have a robust set of metrics without you having to upload things and that is on the way.

It is currently pretty far along in validation, and we are currently beta-testing at our site, and there are several other sites that are doing this as well. Because it is going through this kind of electronic transformation and upload called FHIR, or I think it's F H I R, which is sort of HL7 on steroids, you'll basically don't have to do any work, and they'll be doing some of this work for you.

It is voluntary at first. You don't have to do it, as I understand it. You know, I think NHSN has been working with me and a number of other experts, and they realize the eCQMs, while important, are not adequate. So they're adding measures to replicate. In large part, the SHM measures, including measures by patient day and patient stay units of analysis, measures with more cutoffs for hypoglycemia.

And they will be able to group, they'll be able to look at individual units and groups of units, groups of like units, and report out how you're doing compared to others in the future. They're also looking at risk adjustment by both patient and institutional parameters. So, I think this is really going to be the game changer more than the eCQMs, and, I don't know exactly what the timeline is, but I suspect, within three years, your hospital will be getting reports on this.

And they're very clear about their intentions about how they're going to do this. So, first, they're going to be looking on your internal use at hospitals, and they've, this is their slide from the NHSN. Hospital's internal own performance without reference performance measures are the hospitals that comes first.

Then they start doing this benchmarking, but without public reporting, and eventually they're going to go to public reporting, and then pay for performance, and then likely accreditation. So, this is already mapped out. This is, I think, their plan, and it's coming not just for this, but also for some other measures, like hospital acquired VTE or venous thromboembolism and others.

So I think it's an aggressive agenda, but one that they've spent years perfecting. And, I do think it will be very, very helpful in not only raising awareness, but also informing improvement efforts.

So when we had these terrible 10 performers, if you will, the struggling sites or middling performers for that matter, we go through a list of things that try to get them going, break that negative momentum, break that negative inertia, and get them moving in the right direction. And the first thing is really to review your SubQ and insulin infusion order sets and make sure they have the right kind of clinical decision support to support best practices.

And aligning your order sets with the best practice algorithm. It helps to really... Draw out that algorithm and potentially you might need to revise your EMR order sets if you're able to do that. This is an example of how we started way back when at UC San Diego with a very simple front and back of a page algorithm for SubQ insulin.

We basically asked patients or asked providers to stop the non insulin antihyperglycemic agents. We gave them guidance about how to calculate the dose of insulin. About, or about whether or not they really needed to have insulin and then how to distribute that in basal versus nutritional insulin based on if they were eating or if they were on continuous tube feeds or TPN or if they were NPO and what do you do in those different situations.

It's really not difficult, but the first time you walk people through it, and you know, if you just ask them, okay, what do you do now, they sometimes look like a deer in the headlights, but if you walk them through a few cases, they get it pretty quickly, and then you reevaluate, and we reinforce basic terminology like basal insulin, is the insulin they need all the time, whether eating or not.

Nutritional insulin, that reinforces that if you stop nutrition, that carbohydrate associated with nutrition, you should stop the nutritional insulin. Otherwise, they can get hypoglycemic. And then correction insulin is temporary fix. And if you're using it a lot, you need to add basal insulin. The target range, that's important.

Stopping oral meds, again, all the other guidance can fit on the front and back of a page. It doesn't make them expert, but it gets them going. And then you take the same guidance and try to make sure it's built into your order set in a way that flows. Which can be complex, but there are examples both in that SHM implementation guide I showed you and several other best performers have succeeded in constructing high quality, more intuitive order sets that walk people through this relatively complex order set procedure.

So, sometimes the sites... are struggling because they just haven't got key groups on board. And in most hospitals, those key groups will consist of groups that take care of large portion of your patients, like hospitalists, pulmonary critical care physicians for the ICU, big surgical groups, and then if you're in a teaching institution, residency groups and chief residents and fellows.

And so getting some people, some influential people from those groups on board is immensely helpful and a good first step. And you can go where the friendliest group is and go from there. You have to, you know, consider your targets, try to set some goals, do some demonstration projects on, you know, 20 patients, show them that it's safe, show them that they're not getting hypoglycemic just because you started a modest dose of basal insulin.

And very importantly, set the expectation that you're putting these order sets In place with the expectation that they will be used when it's appropriate to do so. And that bypassing them is to be frowned upon. So sometimes that involves getting your institutional leaders involved and having them engage, maybe setting up an incentive program or a goal with some of those influential groups.

But if they bypass the tools that guide 'em down the course, then you know, it won't, won't be merely nearly as effective as, as if they're following. The tool is designed to help them perform better. We really discourage the use of correction only or sliding scale only regimens with the exception of patients who you're not sure if they're going to be hyperglycemic or substantially hyperglycemic.

They come in and they have a sugar of 120 or 130, fine, put them on sliding scale if they're not insulin dependent, but, not for people with sugars of 200 who've already declared themselves and need a basal insulin. Support an actionable glycemic target, so a lot of sites that's greater than 180 times 2, or sometimes maybe greater than 200, and do a campaign around it, like let's do a 180, or 180 times 2, there's something to do, or whatever corny phrase you want that acts as an earworm and gets people's attention.

I think it's important to look at the hypoglycemia end, and nursing is really key in this, of course. And then a lot of times some of this requires some EMR build. So again, that institutional will to standardize and the support from the institution to make those changes is crucial. And identifying those real time outliers, like I said, is also crucial.

This is one reason I got involved in this field is because we had a patient who had a stroke code, but the blood glucose of eight milligrams per deciliter. This is EPIC. You can see they were on 48 units of Glargine, and then they reduced the dose. They subsequently did okay. But the heartbreaking part about this is that the preceding days, there were clearly documented hypo or going near hypo events.

But that dose of 48 units of Glargine did not change. So predictably, they got lower and lower as their, you know, insulin requirements diminished, as the patient probably was recovering from an acute illness. So this was 100 percent totally preventable. The people have been paying attention. And so that's the message to you, is to prevent this from happening.

You need to, you need to look at not only how many hypoglycemic events do you have, but how many of those are recurrent. And, you know, what are the steps you do to keep them from recurring? This was from a federal interagency, interagency work group that I was part of that looked at the etiologies of hypoglycemic events and then The actions to mitigate them.

Again, most of these are not rocket science. It's like tube feeding gets interrupted, but the insulin doesn't, or the patient starts to go low and nobody makes an adjustment in their insulin, or they stack insulin. They add insulin dose after insulin dose without taking into account how long it takes for that to be metabolized, they stop testing, you know, so all those have mitigating steps you can put into place. 

And one of the most important ones is to have an algorithm for what you do when suddenly nutrition has stopped. Patient pulls their tube feeding or TPN stops or something happens that, or nutrition gets interrupted.

You need some guidance for your staff about how to handle that. Ideally, you put some of this guidance into your EMR. In this case, these are nursing screens that go over hypoglycemia, and then possible contributing factors. And those same factors we saw from that federal emergency work group are enter it up here.

It takes some critical thinking from nurses to think about it and and then take action. So, that's the idea is to make nurses an active line of defense by recognizing the potential etiologies of hypoglycemia and then alerting the physician to it and making changes so the patient doesn't have recurrent hypoglycemia or is likely to.

We've talked about this measurevention or active surveillance. I can't stress enough how impactful this can be, and how quickly it can work. The way you triage or who you have triaged can vary, and the size of the filter, how many people you act on can vary depending on your resources, but the principle is the same.

You're identifying outliers, you're triaging them to see who needs action right now, and you're doing something to nudge the provider in the right direction or else you're just changing yourself.

This is for your future reference. It's basically, again, the most common contributors to iatrogenic hypoglycemia, and then methods to mitigate those contributing factors. The most important, which may be to make sure assessment is part of your hypoglycemia management protocol, not just, not just therapy, not just giving sugar.

All right, so, wrapping up here, I think the CMS eCQMs will raise awareness, but they can't drive improvement efforts. The NHSN metrics are really going to be game changers. They'll be on, they're on the horizon now, they'll be here in the next two or three years, and they will follow that roadmap  I think, and that these will eventually become part of pay for reporting, pay for performance and possibly accreditation type activities for your hospital. 

Because it takes time to turn this around, you know, the complexity of glycemic control in the hospital makes it more like a barge than a speed boat. So you have to start working on these things now to get ahead of the game. And almost every program has some strength and some weakness, but hardly anybody's got everything right, because it's complex, hard to do everything right at the same time.

So, have a look, get some metrics, decide where you need to focus that attention, and get working on it. Those proven strategies I talked about, I think they've been shown over and over again. When we reinforce those with hospitals, they can improve. Provided that they have a modicum of institutional support in the world of standardized.

So I'm going to stop there, open it up for any questions, and then hand it over to Jordan. Thank you.

Jordan Messler: Great. Thanks so much, Greg. If you're having questions, please, put them in the chat. We'll see if we can have time for questions. I have a few minutes that I wanted to really, in essence, reinforce some of the things that you just said in particular. You know, you can't improve what you can't measure, and you've highlighted how important it is to measure, whether getting data through SHM, and now we have these eCQMs, and then really looking to the future, uh, with the CDC measures.

And if you're measuring, you'll want to improve, and really laid out some great strategies for how to improve. Certainly here at Glytec, from my perspective, we certainly want sites to implement Glucommander as well to drive improvement. I thought in the next few minutes, I really wanted to highlight some of the things you just said, but really highlighting, the metrics that we provide our sites at Glytec.

Why the momentum? What the regular regulatory landscape will look like and how Glytec uses data to drive change. So I think you heard from Greg, and if you haven't heard about the measures, you know, the measures are driving momentum, but also, you know, this is the population that we have in the United States growing with diabetes up to 11%, many with prediabetes, 30 to 40 percent in the hospital with diabetes and hyperglycemia.

That number is increasing at sites in the critical care area. It's up to about 50 percent with hyperglycemia. The reason these measures from CMS are here, because we haven't been paying attention. We know hospitals lack sufficient data. We just heard all the solutions that are out there that are proven, but often not implemented.

And these measures exist because there's a lot of variation and preventable hypoglycemia and treatable hyperglycemia. So, you heard a bit about... What's there currently? Hospitals have some metrics, but they're fairly basic. These two eCQMs are out there. Some sites get Joint Commission Certification, but this is really the tip of the iceberg.

You've heard from Greg what's coming. These NHSN measures are coming over the next few years. If you haven't heard about Leapfrog Certification, they just announced strategies to be certified in diabetes excellence through Leapfrog. And we heard the future steps that are most likely. These eCQM measures are elective now, but as we've seen from other measures, they're likely at some point to be mandatory.

They currently pay for reporting the eCQMs, but the evolution is often pay for performance. So what you're seeing now is certainly just the tip of the iceberg. So what do we do here at Glytec? What are our metrics? Certainly what you've heard about the Society Hospital Medicine metrics have been key for sites that don't have access to good data, because this is really a common question.

What data do you have at your hospital that you're regularly able to receive? I certainly recommend reflecting on that, seeing what kind of of course you get, and often what we hear back from sites is it's very minimal, right? How could you improve what you can't measure and what are you measuring? Maybe hypoglycemia, maybe around less than 40 and less than 70 we hear often in one format, percent BGs, but as you heard from Dr.Maynard, it's the percent patient days, percent patient stays that they share at SHM that we have available that the CMS metrics will be for. And then very few filters, maybe by hospital and a system, maybe at the unit level. So, when you're thinking about metrics and analytics, you know, you have sitting on all this data.

We know we have all this glycemic data, a lot of good information from it, but how can we turn that data information into insights and really actionable insights, really that wisdom that we want to gather from the data. And that's how we've been thinking about it here. Um, what are the types of measures?

The hypo rates, the hyper rates, those are the outcomes. How can we get those process measures that are so important to drive change? And then certainly these balancing measures, particularly around hypo and hyperglycemia. And then there's numerous ways to present the data as well in various dashboards.

So at Glytec, we've been thinking through these various metrics, just basic utilization metrics. Can we evaluate the data, not just percent BGs, but make sure we're getting it back to sites as a patient day, patient stay, reflecting what you see from other places that provide data, from what you're going to see for CMS, patients stay, the greater the 300 patient day.

Outcomes by target range. Different populations are often defined by target range. Process measures like IV insulin, and various other measures around admission, discharge, average BG, the number of BGs per patient, and other reports that we're able to provide our sites to not only understand what the value they're getting with Glucommander, but how they can continue to improve.

And then numerous filters to really break down the data to bring it down to the unit level and particular populations. So a quick sneak peek of what our GlucoMetrics dashboards look like. We have several different dashboards that pull up. Here's a, you know, initial screen. We'll pull up six or seven different dashboards, new ones that we're constantly adding as well.

Just a snapshot of these dashboards. Here's an overview dashboard that we provide to sites with the utilization numbers, in range, hypo and hyper ranges and then a snapshot of this snapshot, diving down into hypoglycemia, really showing a story on how they're doing with. Compared to Glucommander average, which are already 50, 70, 90 percent reduced compared to usual care, numerators and denominators, and seeing the data over time.

And this is just a piece of the type of data we're able to provide to sites. We're constantly trying to innovate and improve. We're planning on dashboards that align with the CMS measure, planning on improved baseline analysis, and additional process metrics to really drive those actionable insights. So, reflect on the data that you have.

You've heard some great options from Greg on the data that you can get from SHM and other sites, our sites, what data they're able to get, uh, awareness is coming with these eCQMs. Be sure to tune into our GlucoMetrics customer only session tomorrow and definitely schedule a demo. Please, if you have questions for the session, I think we're out of time for further questions from the audience, but put them in the chat.

We'll get answers back to you on any questions that you have today. I can't thank Dr. Maynard enough for joining us. I really appreciate, Greg, your time here with us today and thanks everybody out in the audience for joining. Take care.

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