Abstract WP441: Clinical Documentation Improvement Quality Project to Improve Risk Adjusted Mortality in Ischemic Stroke

Introduction: Vizient clinical database-resource manager (CDB/RM) is an alliance of Academic Medical Centers and their affiliated hospital that collects data to enhance patient care by aligning cost, quality and market performance. The observed-to-expected mortality (O/E) is a risk-adjusted measure of a hospital’s mortality and is based upon documentation of specific variables associated with mortality. Methods: Our comprehensive stroke program participates in Vizient CDB/RM. We defined observed mortality as the rate of patient deaths in the hospital each month. Expected mortality is calculated as the sum of all individually calculated risks with conditions that affect severity, for discharges each month. The O/E ratio is calculated by dividing observed mortality by the expected mortality. An O/E ratio score higher than 1.0 means the hospital’s mortality is higher than expected. Results: We identified the most common discharge diagnosis-related group (DRG) codes for ischemic stroke used by our neurovascular service in 2018. We used the Academic Medical Center Hospital: Risk Modeling Summary for 2016 to determine the model group that was relevant for our population. We chose Model group 23 as the highest yield, as that model covers nearly half our volume based upon our frequently used DRG codes. The team used a shared mortality risk factor standard template to improve documentation practices. The Quality Intervention (QI) plan was implemented July 22, 2019 using an interdisciplinary approach. Clinical teams were educated on specific documentation of variables associated with in-hospital mortality. Vizient CDB/RM data on stroke mortality will be reviewed in September 2019 to determine the effect of the QI on mortality O/E ratio for our ischemic stroke population. Conclusions: Our comprehensive stroke program implemented a clinical documentation improvement QI plan to improve Vizient CDB/RM Risk Adjusted Mortality for our ischemic stroke population. We expect that improving appropriate documentation will assist coding specialist to capture the severity of cases, which should improve the mortality O/E ratio.