Key result
Preoperative quality improvement initiative increases coded comorbidity diagnoses ~4-fold per encounter.
Why the study?
To evaluate whether inpatient-adjusted surgical risk and quality outcome measures can be impacted by interventions to improve documentation in the preoperative evaluation clinic.
Does a quality improvement initiative focusing on documentation improve the capture of comorbidities and surgical risk metrics in a preoperative evaluation clinic?
Cohort (n=2,094)
No
Does a quality improvement initiative focusing on documentation improve the capture of comorbidities and surgical risk metrics in a preoperative evaluation clinic?
Structured interventions to improve medical documentation in a preoperative clinic significantly increase the capture of patient comorbidities, which in turn leads to more accurate and typically higher risk-adjusted expected surgical outcome metrics.
Answers are grounded in this paper and cite their sources.
Documentation QI boosts preoperative comorbidity capture; leaves open effects on risk-adjusted surgical metrics and outcomes.
Objective To prove that inpatient-adjusted surgical risk and quality outcome measures can be considerably impacted by interventions to improve documentation in the preoperative evaluation (POE) clinic. Patients and Methods We designed a quality improvement project with a multidisciplinary team in our POE clinic to more accurately reflect surgical risk and impact expected surgical quality outcomes through improved documentation. Interventions included an improved patient record acquisition process and extensive POE provider education regarding patient comorbidities' documentation. For patients admitted after their planned operations, POE clinic comprehensive evaluation notes were linked to inpatient History and Physical notes. High complexity patients seen from October 1, 2018 to December 31, 2018 were the preintervention cohort, and the patients seen from January 1, 2019 to December 31, 2019 were the postintervention cohort. Results The primary outcome measures included the total number of coded diagnoses per encounter and the number of coded hierarchical condition categories per encounter. The secondary outcomes included the calculated severity of illness, risk of mortality, case-mix index, and risk-adjustment factor. Postintervention results show statistically significant increases in all primary outcomes with a P <.05. All secondary outcome measures reported positive change. Conclusion Our interventions confirm that a comprehensive POE and thorough documentation provide a more accurate clinical depiction of the preoperative patient, which in turn impacts quality outcomes in inpatient surgical settings. These results are impactful for direct and indirect patient care and publicly reported hospital and provider level performance data.
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Smerina et al. (2023) conducted a cohort in High complexity preoperative surgical patients (n=2,094). Improved documentation processes (provider education and outside medical record acquisition) vs. Standard documentation (pre-intervention) was evaluated on Total number of coded diagnoses per encounter (DCPE) (p=<0.001). Quality improvement interventions to enhance comorbidity documentation in a preoperative evaluation clinic significantly increased the median number of coded diagnoses per encounter from 2 to 8 (P<0.001).
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