Optimizing Neuroscience Mortality: A Collaborative Approach to Documentation Improvement.

Area of Science:

• Medical quality improvement
• Clinical documentation integrity
• Neuroscience patient outcomes

Background:

• Accurate documentation of patient comorbidities is crucial for determining expected mortality in neuroscience.
• The mortality index, a ratio of observed-to-expected mortality, is influenced by documentation thoroughness.
• Optimizing the mortality index aids in assessing care quality, improving service-line rankings, and affecting reimbursement.

Purpose of the Study:

• To review neuroscience documentation and identify opportunities for improvement.
• To optimize the mortality index for a more accurate assessment of care quality.
• To enhance the accuracy of expected mortality calculations in high-acuity neuroscience patients.

Main Methods:

• An interprofessional team (neurologist, clinical documentation integrity specialists) reviewed 70 mortality charts over 9 months.
• Common documentation gaps in high-acuity neuroscience patients were identified.
• Expected mortality was compared pre- and post-review using Vizient Inc.'s risk adjustment method.

Main Results:

• Documentation improvement opportunities were found in 60% of charts.
• Underreported conditions included aspiration pneumonia, shock, and encephalopathy.
• The average number of mortality-affecting diagnoses per patient increased significantly (4.3 to 7.8), and expected mortality rose from 0.33 to 0.42 (p < 0.0001).

Conclusions:

• Physician and clinical documentation integrity specialist collaboration optimizes expected mortality calculations.
• Identifying and addressing documentation gaps specific to neuroscience patients is key.
• Neurologist engagement in clinical documentation integrity is vital for improving neurology physician documentation education.