Closing the documentation gap: CDI physician advisor education and its effect on quality metrics.

Abstract

104 Background: Inpatient mortality is a powerful patient safety benchmark and is a key performance metric used as a measure for hospital quality rankings and value-based payments from the Centers for Medicare and Medicaid Services (CMS). The objective of this study was to improve expected mortality by improving documentation and capture of Elixhauser comorbidities of complex patients at a Comprehensive Cancer Center. A Clinical Documentation Integrity (CDI) Physician Advisor (PA) program was implemented in July 2024 at our institution to assist in documentation improvement. Initial analysis revealed under-documentation of active patient comorbidities, yielding suboptimal expected mortality (EM) and quality scores. Methods: Pre-operative Assessment Clinic (OPAC) note templates were standardized to improve comorbidity capture and ensure consistency. We then designed a workflow in the electronic health record (EHR) to link these OPAC notes to the surgical History & Physical (H&P). This process simplified H&P completion, decreased redundant documentation, and improved documentation of comorbidities. This process was initially piloted in ENT and then expanded to Colorectal Surgery (CRS). CDI Physician Advisors (PAs) provided education to CRS residents, fellows, faculty, and advanced practice providers (APPs) in March 2025. CRS department leadership, APP liaisons, surgery program director and CRS fellowship directors all committed to the initiative. This study was developed using Plan-Do-Study-Act (PDSA) methodology. Impact was assessed using descriptive statistics. A statistical process control dashboard was developed for ease of visualization. Results: Pre-intervention from July 2021 to March 2025, 26.98% of eligible elective surgical H&Ps were linked to corresponding OPAC notes. Post intervention, April to June 2025, this rose to 70.56% of eligible notes linked. The expected mortality increased from 1.0% to 1.36% post-education, reflecting improved capture of existing comorbidities. The case-mix index (CMI) was 2.37 pre-intervention and 2.29 post intervention reflecting similar complexity and resource intensity of the patient population across these time periods. H&P documentation time decreased from 8–14 minutes to 2–3 minutes per chart, reducing clinician documentation burden. Conclusions: Implementation of a Clinical Documentation Integrity–Physician Advisor (CDI-PA) program— electronic health record (EHR) optimization, peer-to-peer education with ongoing process improvement feedback, and incorporating stakeholder engagement – resulted in improved comorbidity capture, decreased documentation burden, and showed a trend of improved expected mortality for CRS. Ongoing efforts include expanding this program to other surgical services at our cancer center as well as developing clinician level scorecards to improve accountability.