Improving expected mortality through CDI physician advisor engagement: Lessons from a comprehensive cancer center.

83 Background: Accurate documentation of oncology patient complexity enables data-driven decisions, improves outcomes, and enhances hospital quality metrics. Inpatient mortality is a heavily weighted key indicator of care quality included in many databases. Methods: A Clinical Documentation Integrity (CDI) Physician Advisor (PA) program was implemented in July 2024 at a comprehensive cancer center to address documentation gaps. Initial analysis revealed under-documentation of active patient comorbidities, yielding suboptimal expected mortality (EM) and quality scores. Using Plan-Do-Study-Act (PDSA) methodology, we standardized Pre-operative Assessment Clinic (OPAC) note templates to improve comorbidity capture and designed an electronic health record (EHR) workflow linking OPAC notes to History & Physical (H&P) documents. This reduced redundant documentation and streamlined H&P completion for elective surgeries. The process was piloted in ENT Oncology. Stakeholders (department leadership, residency director, and physician liaisons) committed to the initiative. In February 2025, CDI PAs provided individualized education to ENT faculty, residents, fellows, and advanced practice providers (APPs), with ongoing performance feedback. Impact was assessed using descriptive statistics and statistical process control dashboard for ease of visualization. Results: Post-intervention, March–May 2025, 100% of eligible ENT surgical H&Ps were linked to OPAC notes. EM increased from a median of 0.83% (range: 0.75–0.92%) to 1.57% post-education, reflecting enhanced comorbidity capture. H&P documentation time decreased from 8–14 minutes to 2–3 minutes per chart, reducing burden and improving clinician satisfaction. Conclusions: Implementation of a multidisciplinary Clinical Documentation Integrity–Physician Advisor (CDI-PA) program—incorporating stakeholder engagement, peer-to-peer education, and electronic health record (EHR) optimization—resulted in measurable improvements in documentation accuracy, patient comorbidity capture, and operational efficiency. Demonstrated success within the ENT oncology service supports broader implementation across additional surgical specialties. Future efforts will focus on expanding the program to all inpatient surgical services within the Comprehensive Cancer Center and developing provider-level scorecards to enhance accountability and engagement. Obs Mortality % Exp Mortality % Mortality Index CMI Before 0.19 0.828 0.224 3.018 After 0 1.57 0 3.31