<status value="active"/> <experimental value="false"/> <date value="2026-01-16T18:18:14+00:00"/> <publisher value="Centers for Disease Control and Prevention (CDC)"/> <contact> <telecom> <system value="url"/> <value value="www.cdc.gov/hiv/"/> </telecom> </contact> <description value="All inpatient encounters (including ED/Observation visits that end within 1 hour of the start of the inpatient encounter) for patients of all ages where at least one diabetes medication was ordered or administered during the encounter that is during the measurement period. 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"/> <usage value="All participating inpatient facilities reporting data to the NHSN Glycemic Control module must be able to report data electronically in adherence to HL7 FHIR US Core FHIR R4.0.1 data standards and specifications and NHSN instructions for reporting dQMs, including the HL7 NHSN dQM Reporting Implementation Guide (https://build.fhir.org/ig/HL7/nhsn-dqm/). "/> <copyright value="Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. "/> <effectivePeriod> <start value="2026-01-01"/> <end value="2026-12-31"/> </effectivePeriod> <author> <name value="Lantana Consulting Group"/> <telecom> <system value="url"/> <value value="https://www.lantanagroup.com/"/> </telecom> </author> <relatedArtifact> <type value="citation"/> <citation value="American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033--46. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Bates, D. W., Levine, D. M., Salmasian, H., et al. (2023). The safety of inpatient health care. New England Journal of Medicine, 388(12), 142--153. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Classen, D. C., Resar, R., Griffin, F., et al. (2011). 'Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs, 30(4), 581--589. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Cook, C. B., Kongable, G. L., Potter, D. J., et al. (2009). Inpatient glucose control: A glycemic survey of 126 U.S. hospitals. Journal of Hospital Medicine, 4(E7), E7--E14. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Curkendall, S. M., Natoli, J. L., Alexander, C. M., et al. (2009). Economic and clinical impact of inpatient diabetic hypoglycemia. Endocrine Practice, 15(3), 302--312. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Egi, M., Bellomo, R., Stachowski, E., et al. (2010). Hypoglycemia and outcome in critically ill patients. Mayo Clinic Proceedings, 85(3), 217--224. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Finfer, S., Liu, B., Chittock, D. R., et al. (2012). Hypoglycemia and risk of death in critically ill patients. New England Journal of Medicine, 367, 1108--1118. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Gates, P. J., Meyerson, S. A., Baysari, M. T., et al. (2018). Preventable adverse drug events among inpatients: A systematic review. Pediatrics, 142, e20180805. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Hulkower RD, Pollack RM, Zonszein J. Understanding hypoglycemia in hospitalized patients. Diabetes Manag (Lond) 2014;4:165-76. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Maynard, G., et al. (2014). How sweet is it? The use of benchmarking to optimize inpatient glycemic control. Diabetes Spectrum, 27, 212--217. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Moghissi ES, Korytkowski MT, DiNardo M. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract 2009;15:353-69. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Society of Hospital Medicine. Glycemic Control for Hospitalists. Optimizing Care, Preventing Hypoglycemia. Available at: https://www.hospitalmedicine.org/clinical-topics/glycemic-control. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Spector, W. D., Limcangco, R., Furukawa, M. F., Encinosa, W. E. (2017). The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization. Medical Care, 55(8), 856--863. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Turchin, A., Matheny, M. E., Shubina, M., et al. (2009). Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care, 32(7), 1153--1157. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Umpierrez, G. E., Isaacs, S. D., Bazargan, N., et al. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. Journal of Clinical Endocrinology \& Metabolism, 87(3), 978--982. "/> </relatedArtifact> <relatedArtifact> <type value="citation"/> <citation value="Wexler, D. J., et al. (2007). Prevalence of hyper- and hypoglycemia among inpatients with diabetes: A national survey of 44 U.S. hospitals. Diabetes Care, 30(2), 367--369. "/> </relatedArtifact> <library value="https://madie.cms.gov/Library/NHSNGlycemicControlHypoglycemiaInitialPopulation"/> <disclaimer value="Disclaimer This performance measure is not a clinical guideline, does not establish a standard of medical care and has not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. This measure and specifications are subject to further revisions. "/> <rationale value="The NHSN Glycemic Control module supports an electronic health record (EHR)- and vendor-neutral standard for reporting patient-level, linked medication and blood glucose data for inpatients. These data support calculation of inpatient medication-related hypoglycemia events by the NHSN application, which are then returned as reports to the facility. "/> <clinicalRecommendationStatement value="Inpatient hypoglycemia can be severe and life-threatening and is associated with longer hospital stays and increased medical costs (Wexler et al., 2007; Curkendall et al., 2009; Cook et al., 2009; Turchin et al., 2009; Egi et al., 2010). The prevalence of inpatient hypoglycemia varies with patient, hospital unit, timing of episodes, and glycemic threshold. Severe hypoglycemia (\<40 mg/dL) occurs in 2%--5% of hospitalized patients with diabetes mellitus (DM), while hypoglycemia \<70 mg/dL has been reported in up to 10% of all patients in the intensive care unit (Finfer et al., 2012). Patients with DM comprise more than 25% of all U.S. inpatient stays and medication-related hypoglycemia events are common causes of adverse drug events (ADEs) that occur in inpatient settings (Bates et al., 2023; Spector et al., 2017). Rates of severe hypoglycemia vary across hospitals, suggesting opportunities for improvement in glycemic-control quality of care (Hulkower et al., 2014; ADA, 2013; Cook et al., 2009). Inpatient hyperglycemia can increase morbidity, prolong hospital stays, and increase the risk of mortality (Maynard et al., 2014; SHM, n.d.; Umpierrez et al., 2002; Kyi et al., 2019; Pratiwi et al., 2021). The prevalence of inpatient hyperglycemia varies depending upon glycemic threshold and setting, but blood glucose \>140 mg/dL likely occurs in approximately one-eighth to one-quarter of hospitalized patients (Pratiwi et al., 2021; Seisa et al., 2022; Barmanray et al., 2024). Tracking patient blood-glucose levels and implementing appropriate interventions may reduce complications associated with both hyperglycemia and hypoglycemia (ADA, 2013; Cook et al., 2009; Korytkowski et al., 2022; Moghissi et al., 2009). "/> <group id="Group_1"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/> <code value="cohort"/> <display value="Cohort"/> </coding> </valueCodeableConcept> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis"> <valueCode value="Encounter"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type"> <valueCodeableConcept> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-type"/> <code value="process"/> <display value="Process"/> </coding> </valueCodeableConcept> </extension> <population id="InitialPopulation_1"> <code> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-population"/> <code value="initial-population"/> <display value="Initial Population"/> </coding> </code> <description value="All inpatient encounters, as well as ED and OBS encounters that end within 1 hour of the start of the inpatient encounter, for patients of all ages where at least one diabetes medication was ordered or administered during the encounter that is during the measurement period. 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<expression value="SDE Encounter Locations"/> </criteria> </supplementalData> <supplementalData id="sde-location"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Location "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Location"/> </criteria> </supplementalData> <supplementalData id="sde-medication"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Medication "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Medication"/> </criteria> </supplementalData> <supplementalData id="sde-blood-glucose-observation"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Blood Glucose Observation "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Blood Glucose Observation"/> </criteria> </supplementalData> <supplementalData id="sde-chief-complaint"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Chief Complaint "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Chief Complaint"/> </criteria> </supplementalData> <supplementalData id="sde-condition"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Condition "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Condition"/> </criteria> </supplementalData> <supplementalData id="sde-coverage"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Coverage "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Coverage"/> </criteria> </supplementalData> <supplementalData id="sde-initial-population-encounters"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Initial Population Encounters "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Initial Population Encounters"/> </criteria> </supplementalData> <supplementalData id="sde-medication-administration"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Medication Administration "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Medication Administration"/> </criteria> </supplementalData> <supplementalData id="sde-medication-request"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Medication Request "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Medication Request"/> </criteria> </supplementalData> <supplementalData id="sde-minimal-patient"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Minimal Patient "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Minimal Patient"/> </criteria> </supplementalData> <supplementalData id="sde-service-request"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Service Request "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Service Request"/> </criteria> </supplementalData> <supplementalData id="sde-ethnicity"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Ethnicity "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Ethnicity"/> </criteria> </supplementalData> <supplementalData id="sde-payer"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Payer "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Payer"/> </criteria> </supplementalData> <supplementalData id="sde-race"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Race "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Race"/> </criteria> </supplementalData> <supplementalData id="sde-sex"> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="individual"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="subject-list"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="summary"/> </extension> <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType"> <valueCode value="data-collection"/> </extension> <usage> <coding> <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/> <code value="supplemental-data"/> </coding> </usage> <description value="SDE Sex "/> <criteria> <language value="text/cql-identifier"/> <expression value="SDE Sex"/> </criteria> </supplementalData> </Measure>

Exception generating Narrative: Unable to Parse HTML - node 'td' has unexpected content ' ' (last text = 'Severe hypoglycemia event: Blood glucose \' at line 831 column 74


  
    
      
    
    
      
        
          
          
          
        
        
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
      
    
    
      
    
  
  
    
  
  
    
      
    
  
  
  
    
    
      
        
        
        
      
    
    
    
  
  
    
    
      
        
        
        
      
    
    
    
  
  
    
    
      
        
        
        
      
    
    
    
  
  
  
  
  <status value="active"/>
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  <publisher value="Centers for Disease Control and Prevention (CDC)"/>
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  <purpose value="The primary objective of the NHSN Glycemic Control module is to measure and benchmark medication-related hypoglycemia and hyperglycemia events within a facility. NHSN uses line-level data on medications and blood glucose reported by facilities to provide analytic reports to inform quality-improvement efforts for glycemic control and track patient safety events. As NHSN collects additional data, an additional objective will be to allow inter-facility benchmarking and evaluate national-level trends of medication-related hypoglycemia over time.
"/>
  <usage value="All participating inpatient facilities reporting data to the NHSN Glycemic Control module must be able to report data electronically in adherence to HL7 FHIR US Core FHIR R4.0.1 data standards and specifications and NHSN instructions for reporting dQMs, including the HL7 NHSN dQM Reporting Implementation Guide (https://build.fhir.org/ig/HL7/nhsn-dqm/).
"/>
  <copyright value="Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets.
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  <effectivePeriod>
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    <citation value="American Diabetes Association. Economic costs of diabetes in the U.S. in 2012. Diabetes Care 2013;36:1033--46.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Bates, D. W., Levine, D. M., Salmasian, H., et al. (2023). The safety of inpatient health care. New England Journal of Medicine, 388(12), 142--153.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Classen, D. C., Resar, R., Griffin, F., et al. (2011). 'Global trigger tool' shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs, 30(4), 581--589.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Cook, C. B., Kongable, G. L., Potter, D. J., et al. (2009). Inpatient glucose control: A glycemic survey of 126 U.S. hospitals. Journal of Hospital Medicine, 4(E7), E7--E14.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Curkendall, S. M., Natoli, J. L., Alexander, C. M., et al. (2009). Economic and clinical impact of inpatient diabetic hypoglycemia. Endocrine Practice, 15(3), 302--312.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Egi, M., Bellomo, R., Stachowski, E., et al. (2010). Hypoglycemia and outcome in critically ill patients. Mayo Clinic Proceedings, 85(3), 217--224.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Finfer, S., Liu, B., Chittock, D. R., et al. (2012). Hypoglycemia and risk of death in critically ill patients. New England Journal of Medicine, 367, 1108--1118.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Gates, P. J., Meyerson, S. A., Baysari, M. T., et al. (2018). Preventable adverse drug events among inpatients: A systematic review. Pediatrics, 142, e20180805.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Hulkower RD, Pollack RM, Zonszein J. Understanding hypoglycemia in hospitalized patients. Diabetes Manag (Lond) 2014;4:165-76.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Maynard, G., et al. (2014). How sweet is it? The use of benchmarking to optimize inpatient glycemic control. Diabetes Spectrum, 27, 212--217.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Moghissi ES, Korytkowski MT, DiNardo M. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Endocr Pract 2009;15:353-69.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Society of Hospital Medicine. Glycemic Control for Hospitalists. Optimizing Care, Preventing Hypoglycemia. Available at: https://www.hospitalmedicine.org/clinical-topics/glycemic-control.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Spector, W. D., Limcangco, R., Furukawa, M. F., Encinosa, W. E. (2017). The marginal costs of adverse drug events associated with exposures to anticoagulants and hypoglycemic agents during hospitalization. Medical Care, 55(8), 856--863.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Turchin, A., Matheny, M. E., Shubina, M., et al. (2009). Hypoglycemia and clinical outcomes in patients with diabetes hospitalized in the general ward. Diabetes Care, 32(7), 1153--1157.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Umpierrez, G. E., Isaacs, S. D., Bazargan, N., et al. (2002). Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. Journal of Clinical Endocrinology \& Metabolism, 87(3), 978--982.
"/>
  </relatedArtifact>
  <relatedArtifact>
    <type value="citation"/>
    <citation value="Wexler, D. J., et al. (2007). Prevalence of hyper- and hypoglycemia among inpatients with diabetes: A national survey of 44 U.S. hospitals. Diabetes Care, 30(2), 367--369.
"/>
  </relatedArtifact>
  <library value="https://madie.cms.gov/Library/NHSNGlycemicControlHypoglycemiaInitialPopulation"/>
  <disclaimer value="Disclaimer This performance measure is not a clinical guideline, does not establish a standard of medical care and has not been tested for all potential applications.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

This measure and specifications are subject to further revisions.
"/>
  <rationale value="The NHSN Glycemic Control module supports an electronic health record (EHR)- and vendor-neutral standard for reporting patient-level, linked medication and blood glucose data for inpatients. These data support calculation of inpatient medication-related hypoglycemia events by the NHSN application, which are then returned as reports to the facility.
"/>
  <clinicalRecommendationStatement value="Inpatient hypoglycemia can be severe and life-threatening and is associated with longer hospital stays and increased medical costs (Wexler et al., 2007; Curkendall et al., 2009; Cook et al., 2009; Turchin et al., 2009; Egi et al., 2010). The prevalence of inpatient hypoglycemia varies with patient, hospital unit, timing of episodes, and glycemic threshold. Severe hypoglycemia (\<40 mg/dL) occurs in 2%--5% of hospitalized patients with diabetes mellitus (DM), while hypoglycemia \<70 mg/dL has been reported in up to 10% of all patients in the intensive care unit (Finfer et al., 2012). Patients with DM comprise more than 25% of all U.S. inpatient stays and medication-related hypoglycemia events are common causes of adverse drug events (ADEs) that occur in inpatient settings (Bates et al., 2023; Spector et al., 2017). Rates of severe hypoglycemia vary across hospitals, suggesting opportunities for improvement in glycemic-control quality of care (Hulkower et al., 2014; ADA, 2013; Cook et al., 2009).

Inpatient hyperglycemia can increase morbidity, prolong hospital stays, and increase the risk of mortality (Maynard et al., 2014; SHM, n.d.; Umpierrez et al., 2002; Kyi et al., 2019; Pratiwi et al., 2021). The prevalence of inpatient hyperglycemia varies depending upon glycemic threshold and setting, but blood glucose \>140 mg/dL likely occurs in approximately one-eighth to one-quarter of hospitalized patients (Pratiwi et al., 2021; Seisa et al., 2022; Barmanray et al., 2024). Tracking patient blood-glucose levels and implementing appropriate interventions may reduce complications associated with both hyperglycemia and hypoglycemia (ADA, 2013; Cook et al., 2009; Korytkowski et al., 2022; Moghissi et al., 2009).
"/>
  <group id="Group_1">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-scoring"/>
          <code value="cohort"/>
          <display value="Cohort"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis">
      <valueCode value="Encounter"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type">
      <valueCodeableConcept>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-type"/>
          <code value="process"/>
          <display value="Process"/>
        </coding>
      </valueCodeableConcept>
    </extension>
    <population id="InitialPopulation_1">
      <code>
        <coding>
          <system value="http://terminology.hl7.org/CodeSystem/measure-population"/>
          <code value="initial-population"/>
          <display value="Initial Population"/>
        </coding>
      </code>
      <description value="All inpatient encounters, as well as ED and OBS encounters that end within 1 hour of the start of the inpatient encounter, for patients of all ages where at least one diabetes medication was ordered or administered during the encounter that is during the measurement period.
"/>
      <criteria>
        <language value="text/cql-identifier"/>
        <expression value="Initial Population"/>
      </criteria>
    </population>
  </group>
  <supplementalData id="sde-encounter-locations">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Encounter Locations
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Encounter Locations"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-location">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Location
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Location"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-medication">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Medication
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Medication"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-blood-glucose-observation">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Blood Glucose Observation
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Blood Glucose Observation"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-chief-complaint">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Chief Complaint
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Chief Complaint"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-condition">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Condition
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Condition"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-coverage">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Coverage
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Coverage"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-initial-population-encounters">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Initial Population Encounters
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Initial Population Encounters"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-medication-administration">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Medication Administration
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Medication Administration"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-medication-request">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Medication Request
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Medication Request"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-minimal-patient">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Minimal Patient
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Minimal Patient"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-service-request">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Service Request
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Service Request"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-ethnicity">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Ethnicity
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Ethnicity"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-payer">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Payer
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Payer"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-race">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Race
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Race"/>
    </criteria>
  </supplementalData>
  <supplementalData id="sde-sex">
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="individual"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="subject-list"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="summary"/>
    </extension>
    <extension url="http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType">
      <valueCode value="data-collection"/>
    </extension>
    <usage>
      <coding>
        <system value="http://terminology.hl7.org/CodeSystem/measure-data-usage"/>
        <code value="supplemental-data"/>
      </coding>
    </usage>
    <description value="SDE Sex
"/>
    <criteria>
      <language value="text/cql-identifier"/>
      <expression value="SDE Sex"/>
    </criteria>
  </supplementalData>
</Measure>