Resident-Led Clinical Documentation Improvement in Cardiology: Early Effects on Risk-Adjusted Quality Metrics

Risk-adjusted quality metrics, including the mortality index and length of stay index, are central to evaluating cardiovascular care, yet documentation gaps can misrepresent institutional performance.

At our rural academic medical center, the Cardiology service line demonstrated a baseline mortality index of 1.40, indicating 40% higher-than-expected mortality. We identified documentation gaps in common cardiology diagnoses as contributing factors.

This quality improvement study, with a retrospective preintervention comparison, analyzed 2,143 Cardiology encounters over 18 months (July 2024-December 2025). A resident-led intervention including resident training, peer review, and clinical documentation improvement specialist collaboration was associated with mortality index improvement from 1.40 to 0.97 (30.7% relative improvement) and length of stay index improvement from 0.91 to 0.85 (6.6%).

A resident-led clinical documentation improvement initiative improved documentation accuracy of patient risk, increasing expected values and correcting artificially elevated quality indices without changing clinical care or actual patient outcomes.